Provider Demographics
NPI:1295879641
Name:CAIN, BRENT DELOS (MSW)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DELOS
Last Name:CAIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10527 SW INDIAN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:KS
Mailing Address - Zip Code:66546-9614
Mailing Address - Country:US
Mailing Address - Phone:785-273-0937
Mailing Address - Fax:785-228-0685
Practice Address - Street 1:3601 SW 29TH ST
Practice Address - Street 2:STE 110
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2015
Practice Address - Country:US
Practice Address - Phone:785-272-3535
Practice Address - Fax:785-272-3536
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 6991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011484Medicare ID - Type UnspecifiedPROVIDER #