Provider Demographics
NPI:1427126309
Name:JONES, MARILYN G (LCSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:G
Last Name:JONES
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 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1127
Mailing Address - Country:US
Mailing Address - Phone:270-256-5099
Mailing Address - Fax:270-504-7021
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347
Practice Address - Country:US
Practice Address - Phone:270-256-5099
Practice Address - Fax:270-504-7021
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100295000Medicaid
KY7100295000Medicaid