1578045720 NPI number — BRAVAS COUNSELING SERVICES-LCSW, PLLC

Table of content: (NPI 1578045720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578045720 NPI number — BRAVAS COUNSELING SERVICES-LCSW, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAVAS COUNSELING SERVICES-LCSW, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1578045720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAPPINGERS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12590-0792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-590-8224
Provider Business Mailing Address Fax Number:
845-440-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-243-7024
Provider Business Practice Location Address Fax Number:
845-440-0036
Provider Enumeration Date:
09/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HINTON
Authorized Official First Name:
TAMEIKA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
845-590-8224

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R075523 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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