| A Safe Place | |
|
4229 Bardstown Rd Ste 214 Louisville KY 40218-3241 | |
| (502) 630-2018 | |
| (502) 630-2018 |
| Full Name | A Safe Place |
|---|---|
| Speciality | Social Worker |
| Location | 4229 Bardstown Rd Ste 214, Louisville, Kentucky |
| Authorized Official Name and Position | Susan Diemer (THERAPIST) |
| Authorized Official Contact | 5025933831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Safe Place 4229 Bardstown Rd Ste 214 Louisville KY 40218-3241 Ph: (502) 630-2018 | A Safe Place 4229 Bardstown Rd Ste 214 Louisville KY 40218-3241 Ph: (502) 630-2018 |
| NPI Number | 1134791106 |
|---|---|
| Provider Enumeration Date | 07/10/2021 |
| Last Update Date | 08/30/2021 |
| Certification Date | 08/30/2021 |
| Medicare PECOS PAC ID | 6608264908 |
|---|---|
| Medicare Enrollment ID | O20211019000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134791106 | NPI | - | NPPES |
| 7100576900 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Susan Diemer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740693977 PECOS PAC ID: 7214264613 Enrollment ID: I20190807004053 |
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