Provider Demographics
NPI:1942786272
Name:NALLY, PHILIP L (MSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:NALLY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3706
Mailing Address - Country:US
Mailing Address - Phone:859-687-9563
Mailing Address - Fax:859-687-9674
Practice Address - Street 1:1618 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3706
Practice Address - Country:US
Practice Address - Phone:859-687-9563
Practice Address - Fax:859-687-9674
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100442110Medicaid