Provider Demographics
NPI:1144488776
Name:HALL, STEPHEN J (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 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 1:2075 BYPASS RD STE 104
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1636
Practice Address - Country:US
Practice Address - Phone:270-422-3971
Practice Address - Fax:270-422-4882
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid
KY0762263Medicare PIN
KY0762359Medicare PIN
KY00207017Medicare PIN
KY0690963Medicare PIN
KY0763559Medicare PIN
KY00206017Medicare PIN
KY0974732Medicare PIN
KY00199019Medicare PIN
KY30605018Medicaid
KY00201019Medicare PIN
KY00200019Medicare PIN