Organization
BRAVE WINGS THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER D. MOORE (OWNER)
(973) 747-0456
Entity
Organization
Contact information
Practice address
155 PASSAIC AVE, FAIRFIELD, NJ 07004-3561
(973) 747-0456
Mailing address
155 PASSAIC AVE, FAIRFIELD, NJ 07004-3561
(973) 747-0456
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/11/2019
Last updated
04/23/2026
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