MEDICARE: MRS. REBECCA L BREWSTER MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	109	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000225352	OTHER		ANTHEM
2	458695	OTHER		VALUE OPTIONS

General Provider Information

NPI Number	:	1740339639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA L BREWSTER MA

Provider Business Mailing Address
First Line	:	6100 DUTCHMANS LN
Second Line	:	SUITE # 303
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3284
Country	:	US
Telephone Number	:	502-896-1850
Fax Number	:	502-896-6863

Provider Business Practice Location Address
First Line	:	6100 DUTCHMANS LN
Second Line	:	SUITE # 303
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3284
Country	:	US
Telephone Number	:	502-896-1850
Fax Number	:	502-896-6863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	11/29/2010

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