Provider Demographics
NPI:1336891530
Name:BRADEN JOSEPHSON PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:BRADEN JOSEPHSON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPHSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-776-5433
Mailing Address - Street 1:3327 80TH ST APT 42
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1371
Mailing Address - Country:US
Mailing Address - Phone:917-776-5433
Mailing Address - Fax:
Practice Address - Street 1:3327 80TH ST APT 42
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1371
Practice Address - Country:US
Practice Address - Phone:917-776-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty