Individual
DELORA K. BOAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CADC
Contact information
Practice address
600 S PRESTON ST, LOUISVILLE, KY 40202-1716
(502) 583-3951
Mailing address
600 S PRESTON ST, LOUISVILLE, KY 40202-1716
(502) 583-3951
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0008
KY
104100000X
Social Worker
Primary
1369
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000056294
ANTHEM GROUP
—
01
—
000000312667
ANTHEM
—
01
—
2748490000
PASSPORT ADVANTAGE
KY
01
—
50704000
MAGELLAN MIS GROUP
—
05
—
65927857
—
KY
01
—
6764
MEDICARE GROUP
KY
01
—
701764000
MAGELLAN MIS
—
05
—
78903689
—
KY
05
—
82000902
—
KY
05
—
82900176
—
KY
01
—
CK2274
MEDICARE RAILROAD GROUP
KY
Enumeration date
05/23/2005
Last updated
11/13/2013
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