Provider Demographics
NPI:1316171622
Name:MIZRAHI-BRACHT, MONICA S (LADAC)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:S
Last Name:MIZRAHI-BRACHT
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:M
Other - Last Name:BRACHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADAC
Mailing Address - Street 1:616 PASEO DE LA CUMA
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1200
Mailing Address - Country:US
Mailing Address - Phone:575-640-0355
Mailing Address - Fax:
Practice Address - Street 1:1129 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2737
Practice Address - Country:US
Practice Address - Phone:505-690-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0073261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)