Basic Information
| Provider Information | |||||||||
| NPI: | 1992961015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | RAMONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3026 BARDSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029150012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3101 BRECKENRIDGE LN STE 1D | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402202793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029150012 | ||||||||
| FaxNumber: | 5025898771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.