Provider Demographics
NPI:1912022252
Name:BRAVO, KARINA S (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:KARINA
Middle Name:S
Last Name:BRAVO
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 UNIVERSITY PKWY
Mailing Address - Street 2:C/O PSYCHOLOGY DEPARTMENT
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2318
Mailing Address - Country:US
Mailing Address - Phone:909-537-5947
Mailing Address - Fax:
Practice Address - Street 1:5500 UNIVERSITY PKWY
Practice Address - Street 2:C/O PSYCHOLOGY DEPARTMENT
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2318
Practice Address - Country:US
Practice Address - Phone:909-537-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist