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Organization

JOHN A. BRACCIO, PH.D., L.L.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN A. BRACCIO PH.D. (OWNER)
(517) 332-0153
Entity
Organization

Contact information

Practice address
1401 E LANSING DR STE 111, EAST LANSING, MI 48823-2992
(517) 332-0153
(517) 332-2960
Mailing address
1401 E LANSING DR STE 111, EAST LANSING, MI 48823-2992
(517) 332-0153
(517) 332-2960

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016571
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OC31931
BLUE CROSS AND BLUE SHIELD PROVIDER NUMBER
MI
Enumeration date
04/01/2016
Last updated
04/01/2016
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