Provider Demographics
NPI:1487894812
Name:BARNETT-ROSE, LIDA SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:LIDA
Middle Name:SUSAN
Last Name:BARNETT-ROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIDA
Other - Middle Name:SUSAN
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-234-8572
Practice Address - Street 1:300 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1492
Practice Address - Country:US
Practice Address - Phone:270-259-4652
Practice Address - Fax:270-234-8572
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker