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General NPI Number Information
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NPI Number | 1164459996
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Entity Type | Individual
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Provider Name | JOHN ROBERT BRADEY JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1201 MILLER ST
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City | MONROE
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State | NC
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Zip | 28110-3026
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Country | US
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Telephone | 704-289-2228
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Fax | 704-291-7150
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Provider Business Mailing Address
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Address Line | 13433 KINTYRE CT
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City | MATTHEWS
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State | NC
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Zip | 28105-3033
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Country | US
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Telephone | 704-849-9126
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Fax | 704-291-7150
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2236
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License Number State | NC
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