Provider Demographics
NPI:1417972522
Name:GORDON BREWSTER, KAY ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:ELAINE
Last Name:GORDON BREWSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CENTRAL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2733
Mailing Address - Country:US
Mailing Address - Phone:814-678-6900
Mailing Address - Fax:814-678-6902
Practice Address - Street 1:19 CENTRAL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2733
Practice Address - Country:US
Practice Address - Phone:814-678-6900
Practice Address - Fax:814-678-6902
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0132521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00207108OtherRAILROAD MEDICARE
PA201297000OtherMAGELLAN
PAP028831OtherCHAMPUS
PA536029OtherBLUE SHIELD
PA536029ZDEJOtherMEDICARE PTAN
PA112220OtherVALUE OPTIONS
PA209106OtherUPMC
PA536029Medicare ID - Type UnspecifiedMEDICARE
PAP00207108OtherRAILROAD MEDICARE