Provider Demographics
NPI:1891063582
Name:BRADEN, MARCIA L (PHD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
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 1:214 E DALE ST
Mailing Address - Street 2:#110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4729
Mailing Address - Country:US
Mailing Address - Phone:719-633-3773
Mailing Address - Fax:719-633-9705
Practice Address - Street 1:214 E DALE ST
Practice Address - Street 2:#110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4729
Practice Address - Country:US
Practice Address - Phone:719-633-3773
Practice Address - Fax:719-633-9705
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1894103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1609913011OtherNPI