Provider Demographics
NPI:1154467082
Name:BRADDEN, CAROL JUBERT
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JUBERT
Last Name:BRADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 W HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-6065
Mailing Address - Country:US
Mailing Address - Phone:901-577-9311
Mailing Address - Fax:901-577-0207
Practice Address - Street 1:427 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-2023
Practice Address - Country:US
Practice Address - Phone:901-577-9311
Practice Address - Fax:901-577-0207
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker