Provider Demographics
NPI:1386475069
Name:FOREMAN-BLACK, BRADEN SCOTT
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:SCOTT
Last Name:FOREMAN-BLACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 S 15TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9617
Mailing Address - Country:US
Mailing Address - Phone:402-483-7900
Mailing Address - Fax:402-483-7971
Practice Address - Street 1:8001 S 15TH ST STE C
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9617
Practice Address - Country:US
Practice Address - Phone:402-483-7900
Practice Address - Fax:402-483-7971
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical