Healthcare Provider Details

I. General information

NPI: 1225482235
Provider Name (Legal Business Name): ERICA BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 MUDDY CREEK RD STE 100
CINCINNATI OH
45238-2058
US

IV. Provider business mailing address

4721 READING RD
CINCINNATI OH
45237-6107
US

V. Phone/Fax

Practice location:
  • Phone: 513-347-0375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: