Provider Demographics
NPI:1447467311
Name:BRAITHWAITE, BARBRA B (LLP)
Entity type:Individual
Prefix:MS
First Name:BARBRA
Middle Name:B
Last Name:BRAITHWAITE
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27790 WEST M-64
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953
Mailing Address - Country:US
Mailing Address - Phone:906-884-4474
Mailing Address - Fax:
Practice Address - Street 1:103 WEST U.S. 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968
Practice Address - Country:US
Practice Address - Phone:906-229-6120
Practice Address - Fax:906-229-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL964866103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL964866OtherLLP