Healthcare Provider Details

I. General information

NPI: 1972265536
Provider Name (Legal Business Name): BRAVER MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 WAMPANOAG TRL STE 3C
RIVERSIDE RI
02915-1217
US

IV. Provider business mailing address

67 BAY RD
BARRINGTON RI
02806-4751
US

V. Phone/Fax

Practice location:
  • Phone: 401-206-0304
  • Fax: 401-343-6466
Mailing address:
  • Phone: 917-697-2890
  • Fax: 401-903-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADY CASE
Title or Position: MEMBER
Credential: MD
Phone: 917-697-2890