Provider Demographics
NPI:1336561083
Name:DEVORE, JENNIFER RAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAYNE
Last Name:DEVORE
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 1:570 E MARKS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40140-5236
Mailing Address - Country:US
Mailing Address - Phone:502-741-7995
Mailing Address - Fax:
Practice Address - Street 1:9850 VON ALLMEN CT STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2855
Practice Address - Country:US
Practice Address - Phone:270-975-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2577821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical