Provider Demographics
NPI:1750479317
Name:BRAVERMAN, AHUVA (PHD)
Entity Type:Individual
Prefix:
First Name:AHUVA
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2216
Mailing Address - Country:US
Mailing Address - Phone:310-535-7014
Mailing Address - Fax:310-829-2454
Practice Address - Street 1:1137 2ND ST STE 109
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5061
Practice Address - Country:US
Practice Address - Phone:310-535-7014
Practice Address - Fax:310-829-2454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical