Provider Demographics
NPI:1427111954
Name:PROUDFOOT, REBECCA H (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:H
Last Name:PROUDFOOT
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 1:916 RED HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9326
Mailing Address - Country:US
Mailing Address - Phone:859-626-8050
Mailing Address - Fax:859-626-8050
Practice Address - Street 1:916 RED HOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9326
Practice Address - Country:US
Practice Address - Phone:859-626-8050
Practice Address - Fax:859-626-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000065642Medicare UPIN
KYCSW0221Medicare ID - Type UnspecifiedMEDICARE BILLIING INFORMA