Healthcare Provider Details

I. General information

NPI: 1609913011
Provider Name (Legal Business Name): MARCIA L BRADEN PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E ST VRAIN STREET SUITE 200
COLORADO SPRINGS CO
80903
US

IV. Provider business mailing address

100 E ST VRAIN STREET SUITE 200
COLORADO SPRINGS CO
80903
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-3773
  • Fax: 719-633-9705
Mailing address:
  • Phone: 719-633-3773
  • Fax: 719-633-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1894
License Number StateCO

VIII. Authorized Official

Name: MARCIA L BRADEN
Title or Position: PRESIDENT
Credential: PHD
Phone: 719-633-3773