Provider Demographics
NPI:1013680339
Name:VEGA BRAVO, GABRIELA MARITA (SOCIAL WORK)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:MARITA
Last Name:VEGA BRAVO
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:MRS
Other - First Name:GABRIELA
Other - Middle Name:MARITA
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SOCIAL WORK
Mailing Address - Street 1:110 S 3RD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5369
Mailing Address - Country:US
Mailing Address - Phone:810-294-1203
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH THIRD STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5346
Practice Address - Country:US
Practice Address - Phone:810-294-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801119460104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical