Individual
MS. DONNA LYNN PROVENZOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3430 NEWBURG RD, SUITE 212, LOUISVILLE, KY 40218-2497
(502) 454-8800
(502) 736-0140
Mailing address
3430 NEWBURG RD, SUITE 212, LOUISVILLE, KY 40218-2497
(502) 454-8800
(502) 736-0140
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
KY2041
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378907
ANTHEM
KY
01
—
369633
TRICARE
KY
01
—
814082000
MAGELLAN
KY
Enumeration date
11/14/2006
Last updated
07/02/2008
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