Healthcare Provider Details

I. General information

NPI: 1093708554
Provider Name (Legal Business Name): GENEIVIVE BREWER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E COLLEGE AVE STE B
STANTON KY
40380-2363
US

IV. Provider business mailing address

638 E COLLEGE AVE STE B
STANTON KY
40380-2363
US

V. Phone/Fax

Practice location:
  • Phone: 606-318-3500
  • Fax: 606-606-3503
Mailing address:
  • Phone: 606-318-3500
  • Fax: 606-606-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY1054
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: