Provider Demographics
NPI:1780809772
Name:BRAATEN, MARGUERITE REGAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:REGAN
Last Name:BRAATEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MR
Other - First Name:PEGGY
Other - Middle Name:REGAN
Other - Last Name:BRAATEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7702 FM 1960 RD E
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2201
Mailing Address - Country:US
Mailing Address - Phone:281-812-7220
Mailing Address - Fax:
Practice Address - Street 1:7702 FM 1960 RD E
Practice Address - Street 2:SUITE 208
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2201
Practice Address - Country:US
Practice Address - Phone:281-812-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSW0080121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSW008012OtherSOCIAL WORK LICENSE
TXS35KOtherBLUE CROSS NO.