Provider Demographics
NPI:1639641236
Name:BRAVE HEART, MARIA YELLOW HORSE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:YELLOW HORSE
Last Name:BRAVE HEART
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:JUDITH OR JUDY
Other - Middle Name:MARIA
Other - Last Name:BRAVEHEART-JORDAN OR JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MSSW, LCSW
Mailing Address - Street 1:UNIVERSITY OF NEW MEXICO DEPARTMENT OF PSYCHIATRY
Mailing Address - Street 2:MSC09 5030, 1 UNM
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-280-0890
Mailing Address - Fax:505-272-6238
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:MSC09 5030, 1 UNM
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-280-0890
Practice Address - Fax:505-272-6238
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9861051041C0700X
NMC-111891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical