Healthcare Provider Details

I. General information

NPI: 1982904504
Provider Name (Legal Business Name): ANIEK BRADLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15190 SW 136TH ST STE 25
MIAMI FL
33196-2618
US

IV. Provider business mailing address

15190 SW 136TH ST STE 25
MIAMI FL
33196-2618
US

V. Phone/Fax

Practice location:
  • Phone: 786-285-2396
  • Fax: 305-254-4339
Mailing address:
  • Phone: 786-285-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT1458
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: