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General NPI Number Information
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NPI Number | 1184837619
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Entity Type | Individual
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Provider Name | THOMAS EDWIN BRAUNER LCSW, PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2657 31ST ST
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City | SANTA MONICA
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State | CA
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Zip | 90405-3012
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Country | US
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Telephone | 310-200-1953
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Fax | 310-289-7811
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Provider Business Mailing Address
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Address Line | 2657 31ST ST
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City | SANTA MONICA
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State | CA
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Zip | 90405-3012
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Country | US
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Telephone | 310-200-1953
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Fax | 310-289-7811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 17862
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License Number State | CA
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