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DELORA K. BOAZ LCSW, CADC

Addiction Substance Use Disorder

Louisville, Kentucky

Provider NPI: 1285637389

Provider Information:
 DELORA K. BOAZ LCSW, CADC
Gender: F
Not Sole Proprietor

Practice Location:
600 S PRESTON ST  LOUISVILLE, KY 40202 US
Tel: 502-583-3951  Fax: --

Business Mailing Address:
600 S PRESTON ST  LOUISVILLE, KY 40202 US
Tel: 502-583-3951  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y104100000XBehavioral Health & Social Service Providers
Social Worker
KY1369
N101YA0400XBehavioral Health & Social Service Providers
Counselor
KY0008

Other Provider Identifiers:

IssuerNumberStateType
MAGELLAN MIS70176400001
ANTHEM GROUP00000005629401
MAGELLAN MIS GROUP5070400001
82900176KY05
PASSPORT ADVANTAGE2748490000KY01
65927857KY05
ANTHEM00000031266701
MEDICARE GROUP6764KY01
82000902KY05
PASSPORT GROUP2748490000KY01
MEDICARE RAILROAD GROUPCK2274KY01
78903689KY05
0676439KY04
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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