Provider Demographics
NPI:1457582090
Name:BRAUN, ERIC GREGORY (LMSW, CCFC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:GREGORY
Last Name:BRAUN
Suffix:
Gender:M
Credentials:LMSW, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-0324
Mailing Address - Country:US
Mailing Address - Phone:716-640-2378
Mailing Address - Fax:
Practice Address - Street 1:3 W SUMMIT ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1151
Practice Address - Country:US
Practice Address - Phone:716-640-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY067782OtherUNIVERSITY OF THE STATE OF NY - OFFICE OF THE PROFESSIONS