Healthcare Provider Details

I. General information

NPI: 1376374033
Provider Name (Legal Business Name): ANDREA BRAVER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WOODCREST AVE
ARDMORE PA
19003-1919
US

IV. Provider business mailing address

615 WOODCREST AVE
ARDMORE PA
19003-1919
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW026991
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: