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General NPI Number Information
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NPI Number | 1902475973
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Entity Type | Organization
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Legal Business Name | BRAVO PSYCHOLOGICAL GROUP, LLC
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 656 QUINCE ORCHARD RD STE 600
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1418
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Country | US
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Telephone | 301-233-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 656 QUINCE ORCHARD RD STE 600
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1418
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Country | US
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Telephone | 301-233-5020
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOLOGIST
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Name | ERIC BRAVO
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Credential | PSY.D.
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Telephone | 301-233-5020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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