Provider Demographics
NPI:1013642636
Name:BRAVE THERAPY LLC
Entity Type:Organization
Organization Name:BRAVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:NBCC
Authorized Official - Phone:508-560-4400
Mailing Address - Street 1:455 STATE RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-5695
Mailing Address - Country:US
Mailing Address - Phone:508-560-4400
Mailing Address - Fax:
Practice Address - Street 1:455 STATE RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5695
Practice Address - Country:US
Practice Address - Phone:508-560-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1285775OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS