Provider Demographics
NPI:1235310293
Name:CAROLYN A BRAVERMAN LCPC
Entity Type:Organization
Organization Name:CAROLYN A BRAVERMAN LCPC
Other - Org Name:CAROLYN BRAVERMAN AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRAVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-520-0222
Mailing Address - Street 1:1100 W LAKE COOK RD
Mailing Address - Street 2:160
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1929
Mailing Address - Country:US
Mailing Address - Phone:847-520-0222
Mailing Address - Fax:847-302-3922
Practice Address - Street 1:1110 W LAKE COOK RD
Practice Address - Street 2:160
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1944
Practice Address - Country:US
Practice Address - Phone:847-520-0222
Practice Address - Fax:847-302-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1235310293OtherBCBS OF IL.