Mary H. Rivera-Brahm, LSW, LICDC-S LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180006589 Issued in IL

Practice address

454 Maple Ave
Berea, OH 44017-1227

Phone

(440) 409-8507

NPI assigned

Jul 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mary Roberts Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1942235395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 MAPLE AVE",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171227",
            "telephone_number": "440-409-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 MAPLE AVE",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171227",
            "telephone_number": "440-409-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA-BRAHM",
        "first_name": "MARY",
        "middle_name": "H.",
        "credential": "LSW, LICDC-S LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "965683",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S-0021092",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180006589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "ROBERTS",
            "credential": "LSW, LICDC-S LCPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Keara Robertson

• Mental Health Counselor in Berea, OH
• Providers in Berea, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.