=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093065286
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE BRADLEY LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2012
-----------------------------------------------------
Last Update Date | 06/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 LAFAYETTE RD # 156
-----------------------------------------------------
City | NORTH HAMPTON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03862-2451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-352-9382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 LAFAYETTE RD # 156
-----------------------------------------------------
City | NORTH HAMPTON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03862-2451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-352-9382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1204
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8089
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------