Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 001678 | CT |
Y | 103TC0700X | Clinical Psychologist | 001678 | CT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 001678 | CT |
NPI | 1083612972 |
---|---|
Provider Name | Dr. Laura J. Ginther Braun |
First Address | Haddam, CT 06438-1250 |
Second Address | West Hartford, CT 06107-2133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4109121 | (05) | CT |