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General NPI Number Information
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NPI Number | 1336494707
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Entity Type | Individual
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Provider Name | COLLEEN BRADLEY M.S.E.D
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Gender | Female
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/22/2012
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Provider Practice Location Address
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Address Line | 8 SERPENTINE LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-3804
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Country | US
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Telephone | 516-506-8060
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Fax | 516-465-9834
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Provider Business Mailing Address
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Address Line | 8 SERPENTINE LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-3804
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Country | US
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Telephone | 516-506-8060
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Fax | 516-465-9834
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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 | 776443
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License Number State | NY
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