Healthcare Provider Details

I. General information

NPI: 1295436517
Provider Name (Legal Business Name): BRADEN JOSEPHSON PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PARK AVE # 7D
NEW YORK NY
10016-2556
US

IV. Provider business mailing address

77 PARK AVE # 7D
NEW YORK NY
10016-2556
US

V. Phone/Fax

Practice location:
  • Phone: 917-776-5433
  • Fax: 917-776-5433
Mailing address:
  • Phone: 917-776-5433
  • Fax: 917-776-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADEN JOSEPHSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 917-776-5433