Provider Demographics
NPI:1952357451
Name:DEDAS, TODD JEFFREY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:JEFFREY
Last Name:DEDAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 EDITH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2274
Mailing Address - Country:US
Mailing Address - Phone:502-581-1171
Mailing Address - Fax:502-583-1991
Practice Address - Street 1:700 E MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1643
Practice Address - Country:US
Practice Address - Phone:502-581-1171
Practice Address - Fax:502-583-1991
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-11261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical