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NPI Code Detail

MEDICARE: MS. GENEIVIVE BREWER LCSW

MEDICARE: MS. GENEIVIVE BREWER LCSW
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
11041C0700XClinical Social WorkerKY1054KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093708554
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GENEIVIVE BREWER LCSW
Provider Business Mailing Address
First Line : 638 E COLLEGE AVE STE B
Second Line :
City : STANTON
State : KY
Zip : 40380-2363
Country : US
Telephone Number : 606-318-3500
Fax Number : 606-606-3503
Provider Business Practice Location Address
First Line : 638 E COLLEGE AVE STE B
Second Line :
City : STANTON
State : KY
Zip : 40380-2363
Country : US
Telephone Number : 606-318-3500
Fax Number : 606-606-3503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 08/20/2020

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