Provider Demographics
NPI:1487728572
Name:BRAUER, BARBARA A (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BRAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568
Mailing Address - Country:US
Mailing Address - Phone:217-824-4905
Mailing Address - Fax:217-824-3570
Practice Address - Street 1:730 NORTH PAWNEE
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568
Practice Address - Country:US
Practice Address - Phone:217-824-4905
Practice Address - Fax:217-824-3570
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204204Medicare ID - Type Unspecified