Provider Demographics
NPI:1851329841
Name:BRADDOCK CENTER FOR BEHAVIORAL MEDICINE
Entity Type:Organization
Organization Name:BRADDOCK CENTER FOR BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-543-1043
Mailing Address - Street 1:200 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7132
Mailing Address - Country:US
Mailing Address - Phone:724-543-1043
Mailing Address - Fax:724-545-1857
Practice Address - Street 1:200 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 240
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7132
Practice Address - Country:US
Practice Address - Phone:724-543-1043
Practice Address - Fax:724-545-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000548L103T00000X
PAPS007325L103T00000X
PASW002354E104100000X
PACW0144411041C0700X
PACW000943L1041C0700X
PACW1035281041C0700X
PAMD025396E2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty