Provider Demographics
NPI:1508848581
Name:BRAVEMAN, ROBIN H (CCC A)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:H
Last Name:BRAVEMAN
Suffix:
Gender:F
Credentials:CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-3103
Mailing Address - Fax:508-368-3104
Practice Address - Street 1:20 WORCESTER CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1312
Practice Address - Country:US
Practice Address - Phone:508-368-3103
Practice Address - Fax:508-368-3104
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7709598OtherAETNA US HEALTHCARE
042472266OtherTHREE RIVERS
AA3615OtherHARVARD PILGRIM HEALTHCAR
MA5104432Medicaid
AD0170OtherBLUE SHIELD INDEMNITY
54935OtherFALLON COMMUNITY HEALTH P
AD0170OtherBLUE CARE ELECT
042472266OtherONE HEALTH PLAN
042472266039OtherTRICARE CHAMPUS
AD0170OtherBLUE SHIELD HMO BLUE
AD0170OtherBLUE CARE ELECT
042472266OtherONE HEALTH PLAN