Provider Demographics
NPI:1700040730
Name:BRAUCH, MARIE R (MA LPC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:R
Last Name:BRAUCH
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 VALLEY AVE
Mailing Address - Street 2:#35
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-3454
Mailing Address - Country:US
Mailing Address - Phone:724-622-4719
Mailing Address - Fax:
Practice Address - Street 1:697 STATE ST
Practice Address - Street 2:#5
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-622-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002937101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001448341OtherBCBS OF W PA