Provider Demographics
NPI:1942354139
Name:BRAUN, DIANN GAIL (MA,LLP)
Entity Type:Individual
Prefix:MS
First Name:DIANN
Middle Name:GAIL
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1255 OAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2539
Mailing Address - Country:US
Mailing Address - Phone:248-608-6563
Mailing Address - Fax:248-414-4053
Practice Address - Street 1:317 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2735
Practice Address - Country:US
Practice Address - Phone:248-414-4050
Practice Address - Fax:248-414-4053
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1572035103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical