Provider Demographics
NPI:1922233485
Name:BRAIT, MICHELLE L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:BRAIT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:PRIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE DOB 503
Mailing Address - Street 2:BOSTON MEDICAL CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5245
Mailing Address - Fax:617-638-6836
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-5245
Practice Address - Fax:617-638-6836
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1165571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical