Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS016002 | PA |
Y | 103TC0700X | Clinical Psychologist | PS016002 | PA |
NPI | 1003001512 |
---|---|
Provider Name | Nancy Allanoff Braveman |
First Address | Philadelphia, PA 19104-3325 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2007 |
Last Update Date | 04/09/2012 |