Provider Demographics
NPI:1700992708
Name:BRAFFORD, RITA JEAN (LCSW, CADC-D)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:JEAN
Last Name:BRAFFORD
Suffix:
Gender:F
Credentials:LCSW, CADC-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 CORPORATE CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4883
Mailing Address - Country:US
Mailing Address - Phone:262-542-3255
Mailing Address - Fax:262-567-5451
Practice Address - Street 1:888 THACKERAY TRL
Practice Address - Street 2:105
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:262-567-5451
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6612-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13350OtherALCOHOL & DRUG COUNSELOR
WV39788800Medicaid