Provider Demographics
NPI:1316226756
Name:BRAVO, RAYNA M (LMHC)
Entity Type:Individual
Prefix:MS
First Name:RAYNA
Middle Name:M
Last Name:BRAVO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 BEDFORD DR STE B2
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1900
Mailing Address - Country:US
Mailing Address - Phone:321-622-8104
Mailing Address - Fax:
Practice Address - Street 1:1299 BEDFORD DR STE B2
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1900
Practice Address - Country:US
Practice Address - Phone:321-622-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH12391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst