Individual
LYNDE REVERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9815 MERIONETH DR, LOUISVILLE, KY 40299-2840
(502) 827-9494
Mailing address
9815 MERIONETH DR, LOUISVILLE, KY 40299-2840
(502) 827-9494
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
254050
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
07/06/2012
Last updated
06/17/2024
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