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General NPI Number Information
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NPI Number | 1851329841
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Entity Type | Organization
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Legal Business Name | BRADDOCK CENTER FOR BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 200 MEDICAL ARTS BLDG SUITE 240
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City | KITTANNING
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State | PA
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Zip | 16201-7132
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Country | US
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Telephone | 724-543-1043
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Fax | 724-545-1857
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Provider Business Mailing Address
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Address Line | 200 MEDICAL ARTS BLDG SUITE 240
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City | KITTANNING
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State | PA
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Zip | 16201-7132
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Country | US
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Telephone | 724-543-1043
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Fax | 724-545-1857
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LOUIS K HAUBER
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Credential | M.D.
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Telephone | 724-543-1043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS000548L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS007325L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW002354E
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW014441
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW000943L
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW103528
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | MD025396E
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD025396E
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License Number State | PA
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