Provider Demographics
NPI:1366295206
Name:BRACERO, MAYTE A
Entity type:Individual
Prefix:
First Name:MAYTE
Middle Name:A
Last Name:BRACERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAYTE
Other - Middle Name:AMARILYS
Other - Last Name:HICHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 S ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-8727
Mailing Address - Country:US
Mailing Address - Phone:201-268-9592
Mailing Address - Fax:
Practice Address - Street 1:205 S ACADEMY RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-8727
Practice Address - Country:US
Practice Address - Phone:201-268-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health