Healthcare Provider Details

I. General information

NPI: 1649827270
Provider Name (Legal Business Name): EMERY QIAN BRAUTIGAN M.S.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1888
US

IV. Provider business mailing address

7900 ERIN MICHELE PKWY APT 420
SEVERN MD
21144-1275
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-1870
  • Fax:
Mailing address:
  • Phone: 817-471-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07442
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: