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NPI Code Detail

MEDICARE: MR. MICHAEL BENJAMIN BRAVERMAN LCSW

MEDICARE:  MR. MICHAEL BENJAMIN BRAVERMAN  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker084414NY

General Provider Information

NPI Number : 1811243421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL BENJAMIN BRAVERMAN LCSW
Provider Business Mailing Address
First Line : 234 26TH ST APT 3L
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-1623
Country : US
Telephone Number : 646-391-3138
Fax Number :
Provider Business Practice Location Address
First Line : 10326 68TH RD
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-3200
Country : US
Telephone Number : 718-261-3330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2012
Last Update Date : 07/21/2022

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