Provider Demographics
NPI:1457591935
Name:BRADEN IBRAHEEM, LEORA ALANE
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:ALANE
Last Name:BRADEN IBRAHEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 COLUMBIA PIKE # 1004
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4402
Mailing Address - Country:US
Mailing Address - Phone:301-200-1188
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE # 1004
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4402
Practice Address - Country:US
Practice Address - Phone:301-200-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical