MEDICARE: MR. DOUGLAS A BRAUN L.I.S.W.

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
1	1041C0700X	Clinical Social Worker	I5700	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	9235411	OTHER	OH	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659555779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS A BRAUN L.I.S.W.

Provider Business Mailing Address
First Line	:	11900 FAIRHILL RD
Second Line	:	SUITE 300
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1062
Country	:	US
Telephone Number	:	216-791-8000
Fax Number	:	216-373-1814

Provider Business Practice Location Address
First Line	:	11900 FAIRHILL RD
Second Line	:	SUITE 300
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1062
Country	:	US
Telephone Number	:	216-791-8000
Fax Number	:	216-373-1814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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Directions to “ MR. DOUGLAS A BRAUN L.I.S.W.” Practice Location

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