Provider Demographics
NPI:1730502014
Name:BRADEN, ABBY (PHD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:BRADEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHOLOGY
Mailing Address - Street 2:BOWLING GREEN STATE UNIVERSITY
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403
Mailing Address - Country:US
Mailing Address - Phone:419-372-9405
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PSYCHOLOGY BOWLING GREEN STATE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-3021
Practice Address - Country:US
Practice Address - Phone:419-372-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical