Provider Demographics
NPI:1013304575
Name:BRAHNAM, S BERLIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:BERLIN
Last Name:BRAHNAM
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 1:4319 S NATIONAL AVE
Mailing Address - Street 2:#259
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2607
Mailing Address - Country:US
Mailing Address - Phone:417-885-9171
Mailing Address - Fax:
Practice Address - Street 1:3543 S LONE PINE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4854
Practice Address - Country:US
Practice Address - Phone:417-885-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst