Provider Demographics
NPI:1922728682
Name:LAW-LOPEZ, BREANNA C
Entity Type:Individual
Prefix:MISS
First Name:BREANNA
Middle Name:C
Last Name:LAW-LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1159
Mailing Address - Country:US
Mailing Address - Phone:502-719-8802
Mailing Address - Fax:
Practice Address - Street 1:9900 CORPORATE CAMPUS DR STE 1000
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4050
Practice Address - Country:US
Practice Address - Phone:502-719-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker