Provider Demographics
NPI:1710551122
Name:BRADEN, JASON C
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:BRADEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-0085
Mailing Address - Country:US
Mailing Address - Phone:510-417-6446
Mailing Address - Fax:925-778-4241
Practice Address - Street 1:1925 GARDEN CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2865
Practice Address - Country:US
Practice Address - Phone:925-778-4749
Practice Address - Fax:925-778-4241
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health