| Brave Space Therapy, Llc | |
|
1600 Hamilton St Allentown PA 18102-4214 | |
| (845) 807-6582 | |
| Not Available |
| Full Name | Brave Space Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1600 Hamilton St, Allentown, Pennsylvania |
| Authorized Official Name and Position | Annalisa Bova (OWNER) |
| Authorized Official Contact | 8458076582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brave Space Therapy, Llc 8108 Heritage Dr Alburtis PA 18011-2721 Ph: (845) 807-6582 | Brave Space Therapy, Llc 1600 Hamilton St Allentown PA 18102-4214 Ph: (845) 807-6582 |
| NPI Number | 1821736588 |
|---|---|
| Provider Enumeration Date | 05/23/2022 |
| Last Update Date | 05/23/2022 |
| Certification Date | 05/23/2022 |
| Medicare PECOS PAC ID | 2163801663 |
|---|---|
| Medicare Enrollment ID | O20220613002638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821736588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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