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General NPI Number Information
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NPI Number | 1528154671
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Entity Type | Individual
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Provider Name | CARLOS DEMETRIO BRAVO GOGNY LCSW, MSW
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 3265 JOHNSON AVE STE 214
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City | BRONX
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State | NY
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Zip | 10463-3539
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Country | US
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Telephone | 917-517-5010
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Fax | 718-548-0979
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Provider Business Mailing Address
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Address Line | 3265 JOHNSON AVE STE 214
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City | BRONX
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State | NY
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Zip | 10463-3539
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Country | US
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Telephone | 917-517-5010
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Fax | 718-548-0979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076184
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License Number State | NY
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