Provider Demographics
NPI:1679714414
Name:JOSEPHSON, BRADEN R (PHD)
Entity type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:R
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PARK AVE # 7D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2556
Mailing Address - Country:US
Mailing Address - Phone:917-776-5433
Mailing Address - Fax:
Practice Address - Street 1:77 PARK AVE # 7D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2556
Practice Address - Country:US
Practice Address - Phone:917-776-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical