Provider Demographics
NPI:1194053157
Name:BRAUN, TRIA (CAPSW, LCSW)
Entity type:Individual
Prefix:
First Name:TRIA
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:CAPSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1230
Mailing Address - Country:US
Mailing Address - Phone:262-342-4357
Mailing Address - Fax:
Practice Address - Street 1:441 MILWAUKEE AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1230
Practice Address - Country:US
Practice Address - Phone:262-342-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7551-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100007583Medicaid