Healthcare Provider Details

I. General information

NPI: 1548143696
Provider Name (Legal Business Name): BRAINLOVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MARYLAND AVE
PHOENIX AZ
85013-1325
US

IV. Provider business mailing address

12621 N TATUM BLVD # 607
PHOENIX AZ
85032-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-6355
  • Fax:
Mailing address:
  • Phone: 602-730-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE CABRAL
Title or Position: CEO, MEDICAL DIRECTOR
Credential: MD
Phone: 602-730-6355