Individual
BRAXTON STAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPMHC
Contact information
Practice address
145 HUGUENOT ST STE 404, NEW ROCHELLE, NY 10801-5237
(914) 355-2440
Mailing address
481 MAIN ST STE 401, NEW ROCHELLE, NY 10801-6360
(914) 355-2440
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P126980
NY
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
12/12/2023
Last updated
03/03/2025
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