Provider Demographics
NPI:1134863723
Name:BIVINS, MARY-ELIZABETH (DSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARY-ELIZABETH
Middle Name:
Last Name:BIVINS
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 ORCHARD GRASS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8642
Mailing Address - Country:US
Mailing Address - Phone:859-797-3306
Mailing Address - Fax:
Practice Address - Street 1:3301 ORCHARD GRASS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8642
Practice Address - Country:US
Practice Address - Phone:859-797-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2560281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical