Provider Demographics
NPI:1568108736
Name:BRACCIA, EMILY R (CT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:BRACCIA
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 BETA DR STE 108
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2335
Mailing Address - Country:US
Mailing Address - Phone:440-460-0140
Mailing Address - Fax:440-460-5413
Practice Address - Street 1:6700 BETA DR STE 108
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2335
Practice Address - Country:US
Practice Address - Phone:440-460-0140
Practice Address - Fax:440-460-5413
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000581603103TC0700X, 101Y00000X
OH581603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical