Provider Demographics
NPI:1659396349
Name:BRAUDE, MIRIAM ROSE (LICSW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ROSE
Last Name:BRAUDE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ENFIELD ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2138
Mailing Address - Country:US
Mailing Address - Phone:617-435-1867
Mailing Address - Fax:
Practice Address - Street 1:6 ENFIELD ST UNIT 3
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2138
Practice Address - Country:US
Practice Address - Phone:617-435-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1109591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical