Provider Demographics
NPI:1023322302
Name:BRAGA, KEVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:BRAGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N CENTRAL RD APT 10H
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7595
Mailing Address - Country:US
Mailing Address - Phone:646-468-6687
Mailing Address - Fax:
Practice Address - Street 1:15 W 28TH ST STE 6F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6410
Practice Address - Country:US
Practice Address - Phone:646-818-9588
Practice Address - Fax:646-738-9662
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0773721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical