Provider Demographics
NPI:1356485981
Name:BRASLER, PAUL B (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:B
Last Name:BRASLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 SANTA ROSA RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5105
Mailing Address - Country:US
Mailing Address - Phone:804-282-9100
Mailing Address - Fax:804-282-3266
Practice Address - Street 1:1503 SANTA ROSA RD
Practice Address - Street 2:SUITE 211
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5105
Practice Address - Country:US
Practice Address - Phone:804-282-9100
Practice Address - Fax:804-282-3266
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945352Medicaid