Provider Demographics
NPI:1861123531
Name:BRAVO, EDWARDO CHRISTOPHER (LMSW)
Entity type:Individual
Prefix:MR
First Name:EDWARDO
Middle Name:CHRISTOPHER
Last Name:BRAVO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 JEROME AVE.
Mailing Address - Street 2:P.O BOX 772
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:929-367-7502
Mailing Address - Fax:
Practice Address - Street 1:2845 UNIVERSITY AVE APT 5E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2312
Practice Address - Country:US
Practice Address - Phone:929-367-7502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115491104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker