Provider Demographics
NPI:1295919918
Name:BRAUN, PAMELA R (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:BRAUN
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 1:2665 E NOB HILL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4428
Mailing Address - Country:US
Mailing Address - Phone:503-588-1007
Mailing Address - Fax:
Practice Address - Street 1:2665 E NOB HILL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4428
Practice Address - Country:US
Practice Address - Phone:503-588-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical