Healthcare Provider Details

I. General information

NPI: 1972955078
Provider Name (Legal Business Name): EMILY BRAUTMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NORTHLAND AVE
BUFFALO NY
14208-1114
US

IV. Provider business mailing address

4979 HARLEM RD
BUFFALO NY
14226-2509
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-8989
  • Fax:
Mailing address:
  • Phone: 716-923-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number007289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: