Provider Demographics
NPI:1174891139
Name:BRAWLEY, JOHN MICHAEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRAWLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FARM TO MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2703
Mailing Address - Country:US
Mailing Address - Phone:845-279-4018
Mailing Address - Fax:
Practice Address - Street 1:20 FARM TO MARKET RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2703
Practice Address - Country:US
Practice Address - Phone:845-279-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062158-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool