Provider Demographics
NPI:1255391603
Name:LASCH, MARY ELLEN (LISW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:LASCH
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 DEEPWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5802
Mailing Address - Country:US
Mailing Address - Phone:502-742-2554
Mailing Address - Fax:502-742-2853
Practice Address - Street 1:214 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 114
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3868
Practice Address - Country:US
Practice Address - Phone:502-640-6288
Practice Address - Fax:502-896-0765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7132OtherMOORE AND ASSOCIATES
KY7132OtherMOORE AND ASSOCIATES
KYCSW0223Medicare ID - Type Unspecified