Provider Demographics
NPI:1083735393
Name:BRATT, MARK A (LSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BRATT
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 8TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1269
Mailing Address - Country:US
Mailing Address - Phone:814-392-1244
Mailing Address - Fax:
Practice Address - Street 1:150 E 8TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1269
Practice Address - Country:US
Practice Address - Phone:814-392-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012872L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA909588OtherHIGHMARK