Healthcare Provider Details

I. General information

NPI: 1144147968
Provider Name (Legal Business Name): BRADLEY MATTHEW PAINTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 PEMBROKE BLVD STE 102
VIRGINIA BEACH VA
23455-6450
US

IV. Provider business mailing address

4624 PEMBROKE BLVD STE 102
VIRGINIA BEACH VA
23455-6450
US

V. Phone/Fax

Practice location:
  • Phone: 757-450-8507
  • Fax:
Mailing address:
  • Phone: 757-450-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: