Provider Demographics
NPI:1154738730
Name:BRAVO, MARINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:BRAVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 NW 82ND AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7601
Mailing Address - Country:US
Mailing Address - Phone:305-591-7303
Mailing Address - Fax:305-591-7344
Practice Address - Street 1:3625 NW 82ND AVE STE 309
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-7601
Practice Address - Country:US
Practice Address - Phone:305-591-7303
Practice Address - Fax:305-591-7344
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW52061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical