Bravely Connected P.L.L.C.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BRAVELY CONNECTED P.L.L.C.

Practice address

71 Raymond Rd Ste 105a
West Hartford, CT 06107-2211

Phone

(860) 335-8765

NPI assigned

Jul 14, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Genesis CamposNPI 1417557026

Title

Licensed Clinical Social Worker

Phone

(860) 335-8765

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Genesis Campos, LCSW

  • Clinical Social Worker
  • West Hartford, CT
  • NPI 1417557026
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1902478324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 RAYMOND RD STE 105A",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 RAYMOND RD STE 105A",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072211",
            "telephone_number": "860-335-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVELY CONNECTED P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "CAMPOS",
        "authorized_official_first_name": "GENESIS",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "860-335-8765"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Bracha
• Robert Locke Bradbury, DMD
• Kaitlyn Rose Bradshaw, PA-C
• Braincare, LLC
• Kenneth Brand
• Brehan Cosgrove, LMFT, LLC
• Zhanna Brel
• Brian Brennan, MS, LPC
• Erin Brennan
• Philip Aaron Brennan

• Adult Mental Health Clinic/Center in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Adult Mental Health Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.