Provider Demographics
NPI:1932361045
Name:BRAUD, SCOTT (BCBA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BRAUD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 EAST GEORGIA RD.
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388
Mailing Address - Country:US
Mailing Address - Phone:864-706-6835
Mailing Address - Fax:864-476-0033
Practice Address - Street 1:751 EAST GEORGIA STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388
Practice Address - Country:US
Practice Address - Phone:864-706-6835
Practice Address - Fax:864-476-0033
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBCBA 1-03-1237225500000X
1-03-1237103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX7450Medicaid