Provider Demographics
NPI:1841017068
Name:ACQUISTO, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ACQUISTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OXFORD LANDING DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8671
Mailing Address - Country:US
Mailing Address - Phone:270-903-1871
Mailing Address - Fax:
Practice Address - Street 1:112 OXFORD LANDING DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8671
Practice Address - Country:US
Practice Address - Phone:270-903-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2557001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical