Provider Demographics
NPI:1528014735
Name:BRAUN, KELLY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BRAUN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 CLOSTER DOCK RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-3129
Mailing Address - Country:US
Mailing Address - Phone:201-750-1008
Mailing Address - Fax:201-501-0808
Practice Address - Street 1:491 CLOSTER DOCK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-3129
Practice Address - Country:US
Practice Address - Phone:201-750-1008
Practice Address - Fax:201-501-0808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051843001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071360Medicare ID - Type Unspecified