Healthcare Provider Details

I. General information

NPI: 1578045720
Provider Name (Legal Business Name): BRAVAS COUNSELING SERVICES-LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ROUTE 9
FISHKILL NY
12524-2560
US

IV. Provider business mailing address

PO BOX 792
WAPPINGERS FALLS NY
12590-0792
US

V. Phone/Fax

Practice location:
  • Phone: 845-243-7024
  • Fax: 845-440-0036
Mailing address:
  • Phone: 845-590-8224
  • Fax: 845-440-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR075523
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TAMEIKA L HINTON
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW-R, BC-TMH
Phone: 845-590-8224