Provider Demographics
NPI:1275936486
Name:BRADEN, WARREN SR (EDD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:BRADEN
Suffix:SR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N LOREL AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2443
Mailing Address - Country:US
Mailing Address - Phone:773-360-1389
Mailing Address - Fax:773-687-9412
Practice Address - Street 1:2715 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1351
Practice Address - Country:US
Practice Address - Phone:773-360-1389
Practice Address - Fax:773-687-9412
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 174H00000X
WI711-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174H00000XOther Service ProvidersHealth Educator