Provider Demographics
NPI:1841350279
Name:SENN, ELIZABETH BRINSON (LCSW BCD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BRINSON
Last Name:SENN
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PARKWAY
Mailing Address - Street 2:MEDICAL ARTS BLDG SUITE 411
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217
Mailing Address - Country:US
Mailing Address - Phone:502-473-7028
Mailing Address - Fax:502-454-0666
Practice Address - Street 1:1169 EASTERN PARKWAY
Practice Address - Street 2:MEDICAL ARTS BLDG SUITE 411
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-473-7028
Practice Address - Fax:502-454-0666
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82004268Medicaid
KY426OtherLCSW LICENSE
KY82004268Medicaid
CSW0072Medicare ID - Type Unspecified