Provider Demographics
NPI:1871535690
Name:BRAVMAN, DEBRA A (LICSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:BRAVMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ALBAN
Other - Last Name:BRAVMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3653
Mailing Address - Country:US
Mailing Address - Phone:508-790-3360
Mailing Address - Fax:508-790-3378
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3653
Practice Address - Country:US
Practice Address - Phone:508-790-3360
Practice Address - Fax:508-790-3378
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111526104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23436Medicare ID - Type Unspecified