Provider Demographics
NPI:1659555779
Name:BRAUN, DOUGLAS A (LISW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:BRAUN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 FAIRHILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1062
Mailing Address - Country:US
Mailing Address - Phone:216-791-8000
Mailing Address - Fax:216-373-1814
Practice Address - Street 1:11900 FAIRHILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1062
Practice Address - Country:US
Practice Address - Phone:216-791-8000
Practice Address - Fax:216-373-1814
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI57001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959539Medicaid
OH9235411OtherMEDICARE PART B