NPIMap

Individual provider Active NPI

Bethany Graham, LCSW

  • Social Worker
  • Elizabethtown, KY
National Provider Identifier
1679736045
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
3562 Issued in KY
Practice address
1311 N Dixie Ave
Elizabethtown, KY 42701-2621
Phone
(270) 769-1311
NPI assigned
Jul 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 5210 KY
Clinical Social Worker 1041C0700X 3562 KY
Social Worker 104100000X 3562 KY Primary

Addresses

Primary practice location

1311 N Dixie Ave
Elizabethtown, KY 42701-2621

Mailing address

118 W Union St
Munfordville, KY 42765-8911

Other practice location 1

118 W Union St
Munfordville, KY 42765-8911
Phone (270) 524-9883

Other identifiers 1

IdentifierTypeStateIssuer
7100308470MedicaidKY

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5210KYMDSocial Worker
3562KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeskills, Inc. PastSince Apr 19, 2024 Accepting new patients
Graham Family Care LLC Past Accepting new patients
Bradley Recovery Center Clinical PastSince Oct 1, 2024 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1679736045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 W UNION ST",
            "city": "MUNFORDVILLE",
            "state": "KY",
            "postal_code": "427658911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 N DIXIE AVE",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012621",
            "telephone_number": "270-769-1311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 W Union St",
            "address_purpose": "LOCATION",
            "city": "Munfordville",
            "state": "KY",
            "postal_code": "427658911",
            "country_code": "US",
            "telephone_number": "270-524-9883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "BETHANY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-07",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KY",
            "license": "5210",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3562",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KY",
            "license": "3562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100308470",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.