Provider Demographics
NPI:1447940895
Name:HEKMATJAH, BRACHA
Entity type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:HEKMATJAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 JENNER DR APT E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3058
Mailing Address - Country:US
Mailing Address - Phone:424-523-9049
Mailing Address - Fax:
Practice Address - Street 1:2715 JENNER DR APT E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3058
Practice Address - Country:US
Practice Address - Phone:424-523-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD318106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician