Provider Demographics
NPI:1881100196
Name:BRAUCKMANN, KATHERYN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:BRAUCKMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LSW
Mailing Address - Street 1:929 W MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-5539
Mailing Address - Country:US
Mailing Address - Phone:443-904-7174
Mailing Address - Fax:
Practice Address - Street 1:601 S HENDERSON RD STE 203
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4230
Practice Address - Country:US
Practice Address - Phone:610-992-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132327104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker