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General NPI Number Information
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NPI Number | 1154099836
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Entity Type | Individual
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Provider Name | WENDY BRADLEY MS, ATR-BC, CLAT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 642 HILLIARD ST STE 1303
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City | MANCHESTER
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State | CT
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Zip | 06042-2701
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Country | US
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Telephone | 860-933-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 214 BRADFORD CORNER RD
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City | WOODSTOCK VALLEY
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State | CT
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Zip | 06282-2004
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Country | US
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Telephone | 860-933-5530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ART.000012
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License Number State | CT
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