Provider Demographics
NPI:1245621788
Name:ROBERTS CARNEAL, TAYLOR (LCSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ROBERTS CARNEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 KLONWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2704
Mailing Address - Country:US
Mailing Address - Phone:502-594-2415
Mailing Address - Fax:
Practice Address - Street 1:3113 KLONWAY DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2704
Practice Address - Country:US
Practice Address - Phone:502-594-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7131104100000X
KY2525901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker