Provider Demographics
NPI:1003911090
Name:BRAGEN, MAE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:MAE
Middle Name:
Last Name:BRAGEN
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MISS
Other - First Name:MAT
Other - Middle Name:
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 AZORES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565
Mailing Address - Country:US
Mailing Address - Phone:925-458-1438
Mailing Address - Fax:
Practice Address - Street 1:3490 BUSKIRK AVE
Practice Address - Street 2:STE A
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-458-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT5946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist