Provider Demographics
NPI:1821230012
Name:BRAVERMAN, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORTH AVE
Mailing Address - Street 2:APT. 7
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1044
Mailing Address - Country:US
Mailing Address - Phone:908-264-8426
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH AVE
Practice Address - Street 2:APT. 7
Practice Address - City:GARWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07027-1044
Practice Address - Country:US
Practice Address - Phone:908-264-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist