Provider Demographics
NPI:1275636193
Name:GOSNELL, PATRICIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9626
Mailing Address - Country:US
Mailing Address - Phone:502-807-8187
Mailing Address - Fax:502-241-7825
Practice Address - Street 1:6200 CRESTWOOD STA
Practice Address - Street 2:SUITE B
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7418
Practice Address - Country:US
Practice Address - Phone:502-807-8187
Practice Address - Fax:502-241-7825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1850OtherLCSW