Healthcare Provider Details

I. General information

NPI: 1003385022
Provider Name (Legal Business Name): HEATHER BRAVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WAYNE AVE STE 675
SILVER SPRING MD
20910-5676
US

IV. Provider business mailing address

14428 ALBEMARLE POINT PL
CHANTILLY VA
20151-1749
US

V. Phone/Fax

Practice location:
  • Phone: 240-292-1719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: