Provider Demographics
NPI:1740339639
Name:BREWSTER, REBECCA L (MA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 DUTCHMANS LN
Mailing Address - Street 2:SUITE # 303
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3284
Mailing Address - Country:US
Mailing Address - Phone:502-896-1850
Mailing Address - Fax:502-896-6863
Practice Address - Street 1:6100 DUTCHMANS LN
Practice Address - Street 2:SUITE # 303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3284
Practice Address - Country:US
Practice Address - Phone:502-896-1850
Practice Address - Fax:502-896-6863
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000225352OtherANTHEM
458695OtherVALUE OPTIONS
458695OtherVALUE OPTIONS
KY3016801Medicare ID - Type Unspecified