Provider Demographics
NPI:1528630670
Name:BRAUNSTEIN, AVIGAIL (MS, BCBA)
Entity type:Individual
Prefix:
First Name:AVIGAIL
Middle Name:
Last Name:BRAUNSTEIN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4811
Mailing Address - Country:US
Mailing Address - Phone:845-866-8516
Mailing Address - Fax:
Practice Address - Street 1:1439 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5440
Practice Address - Country:US
Practice Address - Phone:732-523-2327
Practice Address - Fax:732-544-0364
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
12149877103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst