Provider Demographics
NPI:1467518787
Name:BRAUN, MOLLIE LEE (MOLLIE BRAUN APRN)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:LEE
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MOLLIE BRAUN APRN
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:LEE
Other - Last Name:FREESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOLLIE BRAUN APRN
Mailing Address - Street 1:132 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9525
Mailing Address - Country:US
Mailing Address - Phone:413-529-9412
Mailing Address - Fax:
Practice Address - Street 1:489 WHITNEY AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2711
Practice Address - Country:US
Practice Address - Phone:413-532-6777
Practice Address - Fax:413-532-6744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75897PC364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0807OtherBCBSMA
MA1859978OtherMASSHEALTH QMB
MA1859978OtherMASSHEALTH QMB
MAS71269Medicare UPIN