Provider Demographics
NPI:1003108705
Name:BRAUCH, STEPHANIE (MHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BRAUCH
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RED LODGE DR
Mailing Address - Street 2:UNIT # 2
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-4540
Mailing Address - Country:US
Mailing Address - Phone:973-951-6171
Mailing Address - Fax:845-344-0510
Practice Address - Street 1:41 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6489
Practice Address - Country:US
Practice Address - Phone:845-342-5789
Practice Address - Fax:845-344-0510
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health