Active NPI
Connie Haxby, LCSW
- Clinical Social Worker
- Louisville, KY
National Provider Identifier
1104197938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 3597
- Practice address
- 125 Chenoweth LN
Suite 111
Louisville, KY 40207-2641 - Phone
- (502) 439-5323
- Fax
- (502) 415-7152
- NPI assigned
- Jan 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 3597 | KY | Primary |
Addresses
Primary practice location
125 Chenoweth LN
Suite 111
Louisville, KY 40207-2641
Mailing address
125 Chenoweth LN
Suite 111
Louisville, KY 40207-2641
Phone (502) 439-5323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 16, 2018 through Jan 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328054400000",
"number": "1104197938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 CHENOWETH LN",
"address_2": "SUITE 111",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402072641",
"telephone_number": "502-439-5323",
"fax_number": "502-415-7152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 CHENOWETH LN",
"address_2": "SUITE 111",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402072641",
"telephone_number": "502-439-5323",
"fax_number": "502-415-7152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAXBY",
"first_name": "CONNIE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-25",
"last_updated": "2012-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "3597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.