Basic Information
| Provider Information | |||||||||
| NPI: | 1508848581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAVEMAN | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | CCC A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683103 | ||||||||
| FaxNumber: | 5083683104 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 WORCESTER CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683103 | ||||||||
| FaxNumber: | 5083683104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 107 | MA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7709598 | 01 | AETNA US HEALTHCARE | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | AA3615 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 5104432 | 05 | MA | MEDICAID | AD0170 | 01 | BLUE SHIELD INDEMNITY | OTHER | 54935 | 01 | FALLON COMMUNITY HEALTH P | OTHER | AD0170 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266039 | 01 | TRICARE CHAMPUS | OTHER | AD0170 | 01 | BLUE SHIELD HMO BLUE | OTHER |