Provider Demographics
NPI:1104850296
Name:BRAUN-HARVEY, DOUGLAS (MFT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:BRAUN-HARVEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3812
Mailing Address - Country:US
Mailing Address - Phone:619-528-8360
Mailing Address - Fax:619-280-8628
Practice Address - Street 1:3110 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 219
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3812
Practice Address - Country:US
Practice Address - Phone:619-528-8360
Practice Address - Fax:619-280-8628
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT17724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist