Provider Demographics
NPI:1629125257
Name:BRAUER, SHELLEY (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:BRAUER
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6478
Mailing Address - Country:US
Mailing Address - Phone:617-731-3932
Mailing Address - Fax:617-971-0688
Practice Address - Street 1:124 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6478
Practice Address - Country:US
Practice Address - Phone:617-731-3932
Practice Address - Fax:617-971-0688
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063151041C0700X
CA73291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR PO4114Medicare ID - Type Unspecified