Provider Demographics
NPI:1972265536
Name:BRAVER MEDICAL, PLLC
Entity Type:Organization
Organization Name:BRAVER MEDICAL, PLLC
Other - Org Name:BRAVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-697-2890
Mailing Address - Street 1:67 BAY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4751
Mailing Address - Country:US
Mailing Address - Phone:917-697-2890
Mailing Address - Fax:401-903-2192
Practice Address - Street 1:1275 WAMPANOAG TRL STE 3C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1217
Practice Address - Country:US
Practice Address - Phone:401-206-0304
Practice Address - Fax:401-343-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS01333OtherPSYCHOLOGIST LICENSE
RIPS00846OtherPSYCHOLOGIST LICENSE
RIMD12323OtherMEDICAL LICENSE