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NPI Code Detail

MEDICARE: DR. SHELLEY BRAUER PH.D., LICSW

MEDICARE: DR. SHELLEY BRAUER PH.D., LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker106315MA
21041C0700XClinical Social Worker7329CA

General Provider Information

NPI Number : 1629125257
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHELLEY BRAUER PH.D., LICSW
Provider Business Mailing Address
First Line : 124 HARVARD ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-6478
Country : US
Telephone Number : 617-731-3932
Fax Number : 617-971-0688
Provider Business Practice Location Address
First Line : 124 HARVARD ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-6478
Country : US
Telephone Number : 617-731-3932
Fax Number : 617-971-0688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 07/08/2007

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