Provider Demographics
NPI:1811233968
Name:BRAUN-PAYNE, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRAUN-PAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7792 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-9637
Mailing Address - Country:US
Mailing Address - Phone:720-299-7654
Mailing Address - Fax:
Practice Address - Street 1:7792 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-9637
Practice Address - Country:US
Practice Address - Phone:720-299-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9894861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical