Provider Demographics
NPI:1831753409
Name:SANDRA P BRAVO PSYCHOTHERAPY INC
Entity type:Organization
Organization Name:SANDRA P BRAVO PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:PIKER
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-926-4032
Mailing Address - Street 1:208 S LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1637
Mailing Address - Country:US
Mailing Address - Phone:818-854-0735
Mailing Address - Fax:
Practice Address - Street 1:4405 W RIVERSIDE DR STE 205
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4050
Practice Address - Country:US
Practice Address - Phone:818-854-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty