Basic Information
| Provider Information | |||||||||
| NPI: | 1093136392 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL BRAYMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 344 GATES AVE | ||||||||
| Address2: | APT 4A | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179801120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 344 GATES AVE | ||||||||
| Address2: | APT 4A | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179801120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2014 | ||||||||
| LastUpdateDate: | 01/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRAYMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | JUSTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOTHERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5179801120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 081396 | NY | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 261QM0850X | 081396 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.