Provider Demographics
NPI:1164813911
Name:BRACERAS, MICHELLE KIMBERLY (MA, ED M)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KIMBERLY
Last Name:BRACERAS
Suffix:
Gender:F
Credentials:MA, ED M
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KIMBERLY
Other - Last Name:KAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ED M
Mailing Address - Street 1:9 ROCKAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7931
Mailing Address - Country:US
Mailing Address - Phone:717-525-1911
Mailing Address - Fax:
Practice Address - Street 1:816 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4001
Practice Address - Country:US
Practice Address - Phone:717-243-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health