Provider Demographics
NPI:1144109315
Name:BRAGG, RANDI DAHLIA (LMSW)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:DAHLIA
Last Name:BRAGG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7008
Mailing Address - Country:US
Mailing Address - Phone:347-452-7569
Mailing Address - Fax:
Practice Address - Street 1:339 E 23RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7008
Practice Address - Country:US
Practice Address - Phone:347-452-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker