Healthcare Provider Details

I. General information

NPI: 1730614355
Provider Name (Legal Business Name): NICHOLAS BRADFORD URAM PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 2ND ST STE 401
HARRISBURG PA
17101-1071
US

IV. Provider business mailing address

PO BOX 1595
MIDDLETOWN CT
06457-8095
US

V. Phone/Fax

Practice location:
  • Phone: 860-788-6404
  • Fax:
Mailing address:
  • Phone: 860-788-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS019571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: