Basic Information
Provider Information
NPI: 1003001512
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLANOFF BRAVEMAN
FirstName: NANCY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3440 MARKET ST
Address2: SUITE 410
City: PHILADELPHIA
State: PA
PostalCode: 191043325
CountryCode: US
TelephoneNumber: 2155907532
FaxNumber: 2155904251
Practice Location
Address1: 34TH STREET & CIVIC CENTER BLVD
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 19104
CountryCode: US
TelephoneNumber: 2155907555
FaxNumber: 2155907387
Other Information
ProviderEnumerationDate: 09/07/2007
LastUpdateDate: 09/04/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPS016002PAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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