| NPI | 1619088549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN ROSE ZWANZIG Credentialing Specialist 502-454-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-07-22 |