Healthcare Provider Details

I. General information

NPI: 1225669161
Provider Name (Legal Business Name): BRAVE HEALTH MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH AVE FL 3
MIAMI FL
33136-1112
US

IV. Provider business mailing address

1951 NW 7TH AVE FL 3
MIAMI FL
33136-1104
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax: 727-306-8033
Mailing address:
  • Phone: 305-902-6347
  • Fax: 727-306-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA LINDOW
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-902-6347