Provider Demographics
NPI:1295836948
Name:KELMAN-BRAVO, EMILY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:KELMAN-BRAVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MILBURN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2723
Mailing Address - Country:US
Mailing Address - Phone:516-594-6946
Mailing Address - Fax:
Practice Address - Street 1:8509 151ST AVE
Practice Address - Street 2:SUITE LM
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1301
Practice Address - Country:US
Practice Address - Phone:516-594-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028358-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080668OtherVALUE OPTIONS PROVIDER #
NY107636OtherMHN PROVIDER NUMBER
NY107636OtherMHN PROVIDER NUMBER