Provider Demographics
NPI:1447458203
Name:LEVINE, BRADEN
Entity type:Individual
Prefix:MR
First Name:BRADEN
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63660 BRITTA STREET, BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1519
Mailing Address - Country:US
Mailing Address - Phone:541-848-0098
Mailing Address - Fax:
Practice Address - Street 1:1328 NW PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1519
Practice Address - Country:US
Practice Address - Phone:541-848-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health