MEDICARE: DR. JANE F BRAKE PH.D.

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	103TC1900X	Counseling Psychologist	714	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M128	OTHER	KY	ANTHEM
2	3076	OTHER	KY	CHA, INC.
3	24572	OTHER	KY	UNITED HEALTHCARE
4	81717	OTHER	KY	CIGNA

General Provider Information

NPI Number	:	1588669436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE F BRAKE PH.D.

Provider Business Mailing Address
First Line	:	535 W 2ND ST
Second Line	:	STE 207
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1268
Country	:	US
Telephone Number	:	859-255-4864
Fax Number	:	859-255-5385

Provider Business Practice Location Address
First Line	:	535 W 2ND ST
Second Line	:	STE 207
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1268
Country	:	US
Telephone Number	:	859-255-4864
Fax Number	:	859-255-5385

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/07/2010

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