Healthcare Provider Details

I. General information

NPI: 1932361045
Provider Name (Legal Business Name): SCOTT BRAUD BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 EAST GEORGIA STREET SUITE 100
WOODRUFF SC
29388
US

IV. Provider business mailing address

751 EAST GEORGIA RD.
WOODRUFF SC
29388
US

V. Phone/Fax

Practice location:
  • Phone: 864-706-6835
  • Fax: 864-476-0033
Mailing address:
  • Phone: 864-706-6835
  • Fax: 864-476-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberBCBA 1-03-1237
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1237
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: