Provider Demographics
NPI:1124110242
Name:HEALEY, MARY LYNNE (LCSW, MAC, CAS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNNE
Last Name:HEALEY
Suffix:
Gender:F
Credentials:LCSW, MAC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BRULE ST BLDG 871
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-6100
Mailing Address - Country:US
Mailing Address - Phone:502-626-9892
Mailing Address - Fax:502-626-6140
Practice Address - Street 1:200 BRULE ST BLDG 871
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-6100
Practice Address - Country:US
Practice Address - Phone:502-626-9892
Practice Address - Fax:502-626-6140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical