Provider Demographics
NPI:1104317874
Name:CUNDIFF, ELISABETH ELLEN (MSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ELLEN
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BELMONT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2428
Mailing Address - Country:US
Mailing Address - Phone:606-910-3333
Mailing Address - Fax:606-200-3654
Practice Address - Street 1:250 BELMONT AVE STE 3
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2428
Practice Address - Country:US
Practice Address - Phone:606-910-3333
Practice Address - Fax:606-200-3654
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker