Provider Demographics
NPI:1578084141
Name:BROWN, LAFAYETTE III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAFAYETTE
Middle Name:
Last Name:BROWN
Suffix:III
Gender:M
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:PO BOX 1454
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-4454
Mailing Address - Country:US
Mailing Address - Phone:502-496-3300
Mailing Address - Fax:
Practice Address - Street 1:3934 DIXIE HWY STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4163
Practice Address - Country:US
Practice Address - Phone:502-287-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2545391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100641040Medicaid
KYK31710Medicaid