A Safe Place
Organization Active NPI Clinical Social Worker · Louisville, KY
NPI 1134791106 · NPPES record last updated Aug 30, 2021
Key facts
- NPI
- 1134791106
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- A SAFE PLACE
- Practice address
- 4229 Bardstown Rd Ste 214
Louisville, KY 40218-3241 - Phone
- (502) 630-2018
- Fax
- (502) 630-2018
- NPI assigned
- Jul 10, 2021
- Organization subpart
- No
Authorized official
- Name
- Susan Diemer, LCSW
- Title
- Therapist
- Phone
- (502) 593-3831
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211019000637 | KY | Part B Supplier - Clinic/Group Practice | 6608264908 |
Receives reassigned benefits from 1 practitioner Practice locations: Louisville, KY |
National Provider Directory
Locations
4229 Bardstown Rd
Ste 214
Louisville, KY 40218
Phone (502) 630-2018
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
4229 Bardstown Rd Ste 214
Louisville, KY 40218-3241
Mailing address
4229 Bardstown Rd Ste 214
Louisville, KY 40218-3241
Phone (502) 630-2018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100576900 | Medicaid | KY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Louisville |
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All providers in Louisville, KY · Clinical Social Worker in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.