Provider Demographics
NPI:1861582074
Name:SGROI, JOHN (MSSA, LISW-S, LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SGROI
Suffix:
Gender:M
Credentials:MSSA, LISW-S, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2621
Mailing Address - Country:US
Mailing Address - Phone:270-769-5301
Mailing Address - Fax:
Practice Address - Street 1:1311 N DIXIE AVE
Practice Address - Street 2:COMMUNICARE - MANAGER ACT
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2621
Practice Address - Country:US
Practice Address - Phone:270-769-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00098891041C0700X
KY36861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical