Provider Demographics
NPI:1992374532
Name:BRADEN, CHELSIE C (LCSW)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:C
Last Name:BRADEN
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 1:6280 EQUINE DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4383
Mailing Address - Country:US
Mailing Address - Phone:360-489-5965
Mailing Address - Fax:
Practice Address - Street 1:6280 EQUINE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4383
Practice Address - Country:US
Practice Address - Phone:360-489-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW184601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical