Provider Demographics
NPI:1093783185
Name:BRAVERMAN, LOIS (MSW)
Entity Type:Individual
Prefix:MR
First Name:LOIS
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2833
Mailing Address - Country:US
Mailing Address - Phone:515-277-2324
Mailing Address - Fax:515-277-3226
Practice Address - Street 1:3833 WOODS DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2833
Practice Address - Country:US
Practice Address - Phone:515-277-2324
Practice Address - Fax:515-277-3226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical