Provider Demographics
NPI:1821030875
Name:BRACHFELD, AMY ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ALEXANDRA
Last Name:BRACHFELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FLAG LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1018
Mailing Address - Country:US
Mailing Address - Phone:516-850-9105
Mailing Address - Fax:631-592-8415
Practice Address - Street 1:24 FLAG LN
Practice Address - Street 2:
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1018
Practice Address - Country:US
Practice Address - Phone:516-850-9105
Practice Address - Fax:631-592-8415
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07075011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY234185694OtherUBH
NYNV2541Medicare PIN