Provider Demographics
NPI:1639925019
Name:BRAVO, GABRIEL THOMAS
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:THOMAS
Last Name:BRAVO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 E TREASURE DR
Mailing Address - Street 2:APT 4G
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141
Mailing Address - Country:US
Mailing Address - Phone:786-867-1421
Mailing Address - Fax:
Practice Address - Street 1:7545 E TREASURE DR APT 4G
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4308
Practice Address - Country:US
Practice Address - Phone:786-867-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-337886103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst