Provider Demographics
NPI:1588669436
Name:BRAKE, JANE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:F
Last Name:BRAKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W 2ND ST
Mailing Address - Street 2:STE 207
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1268
Mailing Address - Country:US
Mailing Address - Phone:859-255-4864
Mailing Address - Fax:859-255-5385
Practice Address - Street 1:535 W 2ND ST
Practice Address - Street 2:STE 207
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1268
Practice Address - Country:US
Practice Address - Phone:859-255-4864
Practice Address - Fax:859-255-5385
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY714103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYM128OtherANTHEM
KY3076OtherCHA, INC.
KY24572OtherUNITED HEALTHCARE
KY81717OtherCIGNA
KYM128OtherANTHEM