Organization
BRAVE NORTH THERAPY, LCSW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY FORTIN LCSW-R (OWNER)
(315) 834-2014
Entity
Organization
Contact information
Practice address
2211 STATE ROUTE 31, PORT BYRON, NY 13140-9420
(315) 834-2014
Mailing address
PO BOX 1241, WEEDSPORT, NY 13166-1241
(315) 834-2014
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/25/2025
Last updated
01/08/2026
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