Healthcare Provider Details

I. General information

NPI: 1538452883
Provider Name (Legal Business Name): BRADLEY MORDER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 IRON BRIDGE RD STE 6
FREEHOLD NJ
07728-5305
US

IV. Provider business mailing address

23 N DELSEA DR UNIT B
CLAYTON NJ
08312-1637
US

V. Phone/Fax

Practice location:
  • Phone: 732-242-4710
  • Fax:
Mailing address:
  • Phone: 856-423-7000
  • Fax: 856-423-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC37TC00424100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: