Provider Demographics
NPI:1417286543
Name:BRAVEMAN, STEPHEN L
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:BRAVEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:L
Other - Last Name:BRAVEMAN, L.M.F.T., D.S.T.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, DST
Mailing Address - Street 1:494 ALVARADO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2734
Mailing Address - Country:US
Mailing Address - Phone:831-375-7553
Mailing Address - Fax:
Practice Address - Street 1:494 ALVARADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2734
Practice Address - Country:US
Practice Address - Phone:831-375-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-20
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist