Healthcare Provider Details

I. General information

NPI: 1922233485
Provider Name (Legal Business Name): MICHELLE L. BRAIT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MICHELLE L. PRIVE

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503 BOSTON MEDICAL CENTER
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5245
  • Fax: 617-638-6836
Mailing address:
  • Phone: 617-414-5245
  • Fax: 617-638-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116557
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: