Provider Demographics
NPI:1043476849
Name:MOORE, KAREN D (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DIANE
Other - Last Name:BALLREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:988 HUTCHINS LN
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9329
Mailing Address - Country:US
Mailing Address - Phone:419-630-3805
Mailing Address - Fax:
Practice Address - Street 1:988 HUTCHINS LN
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9329
Practice Address - Country:US
Practice Address - Phone:419-630-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical