Provider Demographics
NPI:1750383253
Name:DENNIS, BRENDA KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY
Last Name:DENNIS
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:P.O. B0X 987
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-251-3666
Mailing Address - Fax:270-251-3506
Practice Address - Street 1:229 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2223
Practice Address - Country:US
Practice Address - Phone:270-251-3666
Practice Address - Fax:270-251-3506
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000033321041C0700X
KY16101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3921291Medicare PIN