Provider Demographics
NPI:1265527634
Name:BRAUN, ABBY LEVERETT (LISW, PHD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LEVERETT
Last Name:BRAUN
Suffix:
Gender:F
Credentials:LISW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BUEN PASTOR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508
Mailing Address - Country:US
Mailing Address - Phone:505-820-2236
Mailing Address - Fax:505-466-1257
Practice Address - Street 1:1800 OLD PECOS TRAIL
Practice Address - Street 2:SUITE P
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-820-2236
Practice Address - Fax:505-466-1257
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-30231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000J9731Medicaid
NM11803OtherPRESBYTERIAN HEALTH PLAN