Provider Demographics
NPI:1427126754
Name:CAIN, MARK ALAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:CAIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:5514 BILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4102
Mailing Address - Country:US
Mailing Address - Phone:502-348-5454
Mailing Address - Fax:502-267-9662
Practice Address - Street 1:105 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1108
Practice Address - Country:US
Practice Address - Phone:502-348-5454
Practice Address - Fax:502-349-6190
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical