Provider Demographics
NPI:1063202794
Name:SQUARE ONE LLC
Entity type:Organization
Organization Name:SQUARE ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-896-2606
Mailing Address - Street 1:6440 DUTCHMANS PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3352
Mailing Address - Country:US
Mailing Address - Phone:502-896-2606
Mailing Address - Fax:
Practice Address - Street 1:6440 DUTCHMANS PKWY FL 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3352
Practice Address - Country:US
Practice Address - Phone:502-896-2606
Practice Address - Fax:502-896-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty