Provider Demographics
NPI:1548431976
Name:BRAUN, LEEBA
Entity Type:Individual
Prefix:
First Name:LEEBA
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 TANEY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4003
Mailing Address - Country:US
Mailing Address - Phone:410-764-2029
Mailing Address - Fax:
Practice Address - Street 1:6506 PARK HEIGHTS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3007
Practice Address - Country:US
Practice Address - Phone:410-764-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG100851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical