Provider Demographics
NPI:1881165348
Name:BRAVERMAN, ANDREA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2931
Mailing Address - Country:US
Mailing Address - Phone:410-443-1914
Mailing Address - Fax:
Practice Address - Street 1:631 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:MD
Practice Address - Zip Code:21623-1201
Practice Address - Country:US
Practice Address - Phone:410-556-6103
Practice Address - Fax:410-556-6035
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist