Provider Demographics
NPI:1104873264
Name:HANCOCK, BETTE S (LCSW)
Entity type:Individual
Prefix:
First Name:BETTE
Middle Name:S
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 US HIGHWAY 42
Mailing Address - Street 2:STE. 201A
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9290
Mailing Address - Country:US
Mailing Address - Phone:502-329-0484
Mailing Address - Fax:502-228-6916
Practice Address - Street 1:9509 US HIGHWAY 42
Practice Address - Street 2:STE. 201A
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9290
Practice Address - Country:US
Practice Address - Phone:502-329-0484
Practice Address - Fax:502-228-6917
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11507484OtherCAQH
KY30605018Medicaid