Provider Demographics
NPI:1235907718
Name:BRAATEN NEUROSCIENCE LLC
Entity Type:Organization
Organization Name:BRAATEN NEUROSCIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAATEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-423-1888
Mailing Address - Street 1:400 VILLAGE PKWY NE APT 138
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4363
Mailing Address - Country:US
Mailing Address - Phone:612-423-1888
Mailing Address - Fax:678-985-4855
Practice Address - Street 1:2701 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5918
Practice Address - Country:US
Practice Address - Phone:612-423-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty