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NPI Code Detail

MEDICARE: STEPHANIE BRAVO

MEDICARE: STEPHANIE BRAVO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.031739IL

General Provider Information

NPI Number : 1245167295
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE BRAVO
Provider Business Mailing Address
First Line : 1501 S CALIFORNIA AVE # 7-140
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1732
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S FAIRFIELD AVE # 5-13
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1782
Country : US
Telephone Number : 773-257-4068
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ STEPHANIE BRAVO ” Practice Location

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