Provider Demographics
NPI:1639843469
Name:FELDHEIM, BRACHA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:BRACHA
Middle Name:
Last Name:FELDHEIM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:BRACHA
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:143 WILLIAMSBURG LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1476
Mailing Address - Country:US
Mailing Address - Phone:732-492-4760
Mailing Address - Fax:
Practice Address - Street 1:143 WILLIAMSBURG LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1476
Practice Address - Country:US
Practice Address - Phone:732-492-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06670100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker