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General NPI Number Information
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NPI Number | 1205604014
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Entity Type | Individual
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Provider Name | BRAXTON STAGE LPMHC
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Gender | Male
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 145 HUGUENOT ST STE 404
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5237
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Country | US
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Telephone | 914-355-2440
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Fax |
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Provider Business Mailing Address
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Address Line | 481 MAIN ST STE 401
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-6360
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Country | US
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Telephone | 914-355-2440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P126980
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License Number State | NY
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