Provider Demographics
NPI:1265443220
Name:BRAVMAN, NINA (MA,EDS)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:BRAVMAN
Suffix:
Gender:F
Credentials:MA,EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2758
Mailing Address - Country:US
Mailing Address - Phone:973-625-7960
Mailing Address - Fax:
Practice Address - Street 1:4 2ND AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2758
Practice Address - Country:US
Practice Address - Phone:973-625-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100096300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37F100096300OtherLMFT