Provider Demographics
NPI:1558889758
Name:KOHANTEB, BRACHA (LMSW)
Entity Type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:KOHANTEB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WALCOTT AVE # 1F
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6333
Mailing Address - Country:US
Mailing Address - Phone:347-831-7126
Mailing Address - Fax:
Practice Address - Street 1:2020 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2329
Practice Address - Country:US
Practice Address - Phone:718-676-4280
Practice Address - Fax:718-676-4299
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY104651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program