Basic Information
| Provider Information | |||||||||
| NPI: | 1962455584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIVENS | ||||||||
| FirstName: | COLLEEN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 259 PARKERS MILL RD | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425013152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066794782 | ||||||||
| FaxNumber: | 6066785296 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 HARDIN LN | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425033814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066796251 | ||||||||
| FaxNumber: | 6066794156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1318 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.