Provider Demographics
NPI:1275847451
Name:BRACA DEO, AIMEE LEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:LEE
Last Name:BRACA DEO
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 1:4 POCONO RD
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2956
Mailing Address - Country:US
Mailing Address - Phone:973-625-0096
Mailing Address - Fax:973-625-0123
Practice Address - Street 1:4 POCONO RD
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2956
Practice Address - Country:US
Practice Address - Phone:973-625-0096
Practice Address - Fax:973-625-0123
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138601Medicaid
NJ4138601Medicaid