Healthcare Provider Details

I. General information

NPI: 1356985089
Provider Name (Legal Business Name): BRAVEHEART THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 NADINE RD APT 101
WESLEY CHAPEL FL
33544-4934
US

IV. Provider business mailing address

1857 NADINE RD
WESLEY CHAPEL FL
33544-4933
US

V. Phone/Fax

Practice location:
  • Phone: 813-451-4359
  • Fax:
Mailing address:
  • Phone: 813-451-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RAVEEN WHITFIELD
Title or Position: OWNER
Credential: LCSW
Phone: 813-451-4359