Provider Demographics
NPI:1346254513
Name:BRADEN, LORRAINE SIMON (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:SIMON
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4208
Mailing Address - Country:US
Mailing Address - Phone:817-249-2437
Mailing Address - Fax:817-810-9585
Practice Address - Street 1:3212 COLLINSWORTH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6580
Practice Address - Country:US
Practice Address - Phone:817-877-3707
Practice Address - Fax:817-810-9585
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12030 LCSW101YM0800X
TX3648 LMFT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611097Medicare ID - Type Unspecified