Provider Demographics
NPI:1902957426
Name:CECIL, HENRY A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:A
Last Name:CECIL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:HANK
Other - Middle Name:A
Other - Last Name:CECIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:70 SAYRE DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1970
Mailing Address - Country:US
Mailing Address - Phone:270-970-1624
Mailing Address - Fax:
Practice Address - Street 1:70 SAYRE DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1970
Practice Address - Country:US
Practice Address - Phone:270-970-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-1246OtherLCSW
KY0025544Medicare ID - Type Unspecified