Basic Information
| Provider Information | |||||||||
| NPI: | 1275629685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3430 NEWBURG RD | ||||||||
| Address2: | STE 210 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402182458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024548800 | ||||||||
| FaxNumber: | 5027360140 | ||||||||
| Practice Location | |||||||||
| Address1: | 3430 NEWBURG RD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402182497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024548800 | ||||||||
| FaxNumber: | 5027360140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0652 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.