Provider Demographics
NPI:1336184449
Name:FAHEY, JAMES EMMET III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EMMET
Last Name:FAHEY
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR
Mailing Address - Street 2:SUITE 562
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-896-1850
Mailing Address - Fax:502-896-6863
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 562
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-896-1850
Practice Address - Fax:502-896-6863
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0988103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0046757Medicare PIN