Provider Demographics
NPI:1396125019
Name:BRAXTON, LISA-MARIE JOSEPHINE (LMHC)
Entity type:Individual
Prefix:
First Name:LISA-MARIE
Middle Name:JOSEPHINE
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12034 QUEENS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1230
Mailing Address - Country:US
Mailing Address - Phone:718-261-5131
Mailing Address - Fax:718-261-5137
Practice Address - Street 1:254 W 31ST ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-274-8558
Practice Address - Fax:212-465-0610
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health