Provider Demographics
NPI:1770621310
Name:BRAUNSDORF, MARK S (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:BRAUNSDORF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SCENIC CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1853
Mailing Address - Country:US
Mailing Address - Phone:860-231-7072
Mailing Address - Fax:203-272-7121
Practice Address - Street 1:664 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4203
Practice Address - Country:US
Practice Address - Phone:860-231-7072
Practice Address - Fax:203-272-7121
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist