Provider Demographics
NPI:1124247655
Name:BRADEN, ADRIENNE MARIE (MSW)
Entity type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:MARIE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 DON LORENZO DR
Mailing Address - Street 2:UNIT 35
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5507
Mailing Address - Country:US
Mailing Address - Phone:310-902-9525
Mailing Address - Fax:323-292-7338
Practice Address - Street 1:2500 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2520
Practice Address - Country:US
Practice Address - Phone:323-751-3805
Practice Address - Fax:323-750-5885
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health