Provider Demographics
NPI:1972604890
Name:BRAUN, LISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 UNION STREET
Mailing Address - Street 2:PSYCHOLOGY SUITE
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-3009
Mailing Address - Country:US
Mailing Address - Phone:518-381-4105
Mailing Address - Fax:518-381-4096
Practice Address - Street 1:1401 UNION STREET
Practice Address - Street 2:PSYCHOLOGY SUITE
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3009
Practice Address - Country:US
Practice Address - Phone:518-381-4105
Practice Address - Fax:518-381-4096
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY41333OtherMVP
6802195003OtherVALUE OPTIONS NYS EMPIRE
NY137187OtherVALUE OPTIONS CDPHP
NY0114C3OtherAPA PARTNERS
000490441001OtherBS NE NY
NY137187OtherVALUE OPTIONS CDPHP