Provider Demographics
NPI:1114341955
Name:BAVOSA, BRIANNE
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:
Last Name:BAVOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEAVERSON BLVD
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7812
Mailing Address - Country:US
Mailing Address - Phone:732-920-2700
Mailing Address - Fax:732-262-0707
Practice Address - Street 1:35 BEAVERSON BLVD
Practice Address - Street 2:BUILDING 6
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7812
Practice Address - Country:US
Practice Address - Phone:732-920-2700
Practice Address - Fax:732-262-0707
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)