Laura A Gaines, LCSW

Individual provider Active NPI Clinical Social Worker · Munfordville, KY

NPI 1306987847 · NPPES record last updated Dec 18, 2017

Key facts

NPI
1306987847
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
3153 (KY)
Practice address
118 West Union St
Munfordville, KY 42765
Phone
(270) 524-9883
Fax
(270) 524-0437
NPI assigned
Feb 9, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
3153KYMDAcute Care Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 3153 KY Yes

Addresses

Primary practice location

118 West Union St
Munfordville, KY 42765

Mailing address

380 Suwannee Trail St
Bowling Green, KY 42103-7956
Phone (270) 901-5000

Other identifiers

IdentifierTypeStateIssuer
7100291210MedicaidKY

Other providers in Munfordville, KY

All providers in Munfordville, KY · Clinical Social Worker in Kentucky

Sources for this page

Verify at the official NPI Registry.