Provider Demographics
NPI:1902293665
Name:BRAUER, MARY M (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:BRAUER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:MAGGIE
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:514 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:IN
Mailing Address - Zip Code:46539-9724
Mailing Address - Country:US
Mailing Address - Phone:317-373-0671
Mailing Address - Fax:574-301-5200
Practice Address - Street 1:514 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:IN
Practice Address - Zip Code:46539-9724
Practice Address - Country:US
Practice Address - Phone:574-301-5100
Practice Address - Fax:574-301-5200
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008068A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical