Provider Demographics
NPI:1164584405
Name:BRAVER, ANGELA (LCSW MFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BRAVER
Suffix:
Gender:F
Credentials:LCSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-0548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9696 CULVER BLVD STE 303
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2759
Practice Address - Country:US
Practice Address - Phone:818-762-3200
Practice Address - Fax:818-762-7208
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15134106H00000X
CALCS77701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW7770Medicare ID - Type Unspecified