Provider Demographics
NPI:1184375271
Name:HART, ABBIGAIL S (LCSW)
Entity type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:S
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ABBIGAIL
Other - Middle Name:SHEA
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6555
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:931 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CECILIA
Practice Address - State:KY
Practice Address - Zip Code:42724-7614
Practice Address - Country:US
Practice Address - Phone:844-435-0900
Practice Address - Fax:270-858-4029
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2563321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100798760Medicaid
15480670OtherCAQH
KY256332OtherLCSW