Basic Information
| Provider Information | |||||||||
| NPI: | 1952360091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAVO | ||||||||
| FirstName: | GISELA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 W 178TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100336556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188398900 | ||||||||
| FaxNumber: | 7188398989 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 E 183RD ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104531242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188398900 | ||||||||
| FaxNumber: | 7188398989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 073212 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.