Healthcare Provider Details

I. General information

NPI: 1992619050
Provider Name (Legal Business Name): BRAVE BUTTERFLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 BELMONT AVE APT 3A
BRONX NY
10458-8264
US

IV. Provider business mailing address

2381 BELMONT AVE APT 3A
BRONX NY
10458-8264
US

V. Phone/Fax

Practice location:
  • Phone: 347-872-0095
  • Fax:
Mailing address:
  • Phone: 347-872-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAWN NYREE MIRANDA
Title or Position: OWNER
Credential:
Phone: 347-872-0095