Provider Demographics
NPI:1336864404
Name:NEWNAM, KATILYNN (LCSW)
Entity type:Individual
Prefix:
First Name:KATILYNN
Middle Name:
Last Name:NEWNAM
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 1:148 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-8726
Mailing Address - Country:US
Mailing Address - Phone:859-408-5930
Mailing Address - Fax:
Practice Address - Street 1:1031 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-9240
Practice Address - Country:US
Practice Address - Phone:606-919-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2573691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical