Individual ProviderCharles ClancySocial WorkerBehavioral Health & Social Service ProvidersPractice Address800 Zorn Ave, Louisville, KY 40206-1433(502) 287-6196PECOS EnrollmentBased on the most recent information from CMS, provider Charles Clancy does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1528088226Provider TypeIndividualFull NameClancy, CharlesCredentialLCSWGenderMaleSole ProprietorYesEnumeration Date7/19/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address800 Zorn Ave, Louisville, KY 40206-1433Phone(502) 287-6196Fax(502) 287-6197Mailing LocationMailing Address12225 Crosswinds Dr, Louisville, KY 40243-2111PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense943Kentucky