| Bravo Psychological Group, Llc | |
|
656 Quince Orchard Rd Ste 600 Gaithersburg MD 20878-1418 | |
| (301) 233-5020 | |
| Not Available |
| Full Name | Bravo Psychological Group, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 656 Quince Orchard Rd Ste 600, Gaithersburg, Maryland |
| Authorized Official Name and Position | Eric Bravo (OWNER, PSYCHOLOGIST) |
| Authorized Official Contact | 3012335020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bravo Psychological Group, Llc 656 Quince Orchard Rd Ste 600 Gaithersburg MD 20878-1418 Ph: (301) 233-5020 | Bravo Psychological Group, Llc 656 Quince Orchard Rd Ste 600 Gaithersburg MD 20878-1418 Ph: (301) 233-5020 |
| NPI Number | 1902475973 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 06/24/2021 |
| Certification Date | 06/24/2021 |
| Medicare PECOS PAC ID | 6800299496 |
|---|---|
| Medicare Enrollment ID | O20240319002970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902475973 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michael A Bluestone |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386707297 PECOS PAC ID: 3577910835 Enrollment ID: I20231129003342 |
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