Healthcare Provider Details

I. General information

NPI: 1235074006
Provider Name (Legal Business Name): RACHEL BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 PALMETTO AVE FL 32789
WINTER PARK FL
32789-4964
US

IV. Provider business mailing address

646 W SMITH ST UNIT 248
ORLANDO FL
32804-5377
US

V. Phone/Fax

Practice location:
  • Phone: 407-714-6362
  • Fax:
Mailing address:
  • Phone: 703-975-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: