Healthcare Provider Details

I. General information

NPI: 1215264791
Provider Name (Legal Business Name): BRADLEY J ALTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 FRANKLIN ST
STAMFORD CT
06901-1014
US

IV. Provider business mailing address

86 WINDING BROOK RD
NEW ROCHELLE NY
10804-2008
US

V. Phone/Fax

Practice location:
  • Phone: 203-352-1800
  • Fax: 203-352-1806
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000883-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: