Provider Demographics
NPI:1093136392
Name:MICHAEL BRAYMAN
Entity Type:Organization
Organization Name:MICHAEL BRAYMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:BRAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:517-980-1120
Mailing Address - Street 1:344 GATES AVE
Mailing Address - Street 2:APT 4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1363
Mailing Address - Country:US
Mailing Address - Phone:517-980-1120
Mailing Address - Fax:
Practice Address - Street 1:344 GATES AVE
Practice Address - Street 2:APT 4A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1363
Practice Address - Country:US
Practice Address - Phone:517-980-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0813961041C0700X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty