Healthcare Provider Details

I. General information

NPI: 1184301996
Provider Name (Legal Business Name): BRIONNA CEDE NICOLE PIGRAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 FAIRWAY STREET SUITE 103
BOWLING GREEN KY
42103
US

IV. Provider business mailing address

1143 FAIRWAY STREET SUITE 103
BOWLING GREEN KY
42103
US

V. Phone/Fax

Practice location:
  • Phone: 812-901-6881
  • Fax:
Mailing address:
  • Phone: 812-901-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001468
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: