Healthcare Provider Details

I. General information

NPI: 1912192931
Provider Name (Legal Business Name): BRAVA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 16TH ST NW
WASHINGTON DC
20012-1406
US

IV. Provider business mailing address

7606 16TH ST NW
WASHINGTON DC
20012-1406
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-2989
  • Fax:
Mailing address:
  • Phone: 561-676-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberPRC13943
License Number StateDC

VIII. Authorized Official

Name: DR. THERESA B. BRADLEY
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 561-676-2989