Provider Demographics
NPI:1760544464
Name:BROWN, CUTIA BACON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CUTIA
Middle Name:BACON
Last Name:BROWN
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 1:2700 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1755
Mailing Address - Country:US
Mailing Address - Phone:502-640-6137
Mailing Address - Fax:502-237-4092
Practice Address - Street 1:2700 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1755
Practice Address - Country:US
Practice Address - Phone:502-640-6137
Practice Address - Fax:502-237-4092
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-20091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100297140Medicaid