Provider Demographics
NPI:1184837619
Name:BRAUNER, THOMAS EDWIN (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWIN
Last Name:BRAUNER
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3012
Mailing Address - Country:US
Mailing Address - Phone:310-200-1953
Mailing Address - Fax:310-289-7811
Practice Address - Street 1:2657 31ST ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3012
Practice Address - Country:US
Practice Address - Phone:310-200-1953
Practice Address - Fax:310-289-7811
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 178621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical