Provider Demographics
NPI:1912078650
Name:MADDY, HOLLY ANN (LCSW LISW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:MADDY
Suffix:
Gender:F
Credentials:LCSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 THOMAS MORE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3488
Mailing Address - Country:US
Mailing Address - Phone:859-431-6333
Mailing Address - Fax:859-341-0310
Practice Address - Street 1:328 THOMAS MORE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3488
Practice Address - Country:US
Practice Address - Phone:859-431-6333
Practice Address - Fax:859-341-0310
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY16381041C0700X, 1041C0700X
OH00092491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82001017Medicaid
KY8200101700Medicaid
KY8200101700Medicaid
KY1208604Medicare PIN