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General NPI Number Information
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NPI Number | 1366792368
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Entity Type | Individual
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Provider Name | SCOTT W BRADLEY MSW, CT, PSYA
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Gender | Male
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 19 WASHINGTON AVE
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City | CHATHAM
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State | NJ
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Zip | 07928-2107
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Country | US
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Telephone | 973-665-1782
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Fax | 973-635-7077
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Provider Business Mailing Address
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Address Line | 19 WASHINGTON AVE
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City | CHATHAM
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State | NJ
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Zip | 07928-2107
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Country | US
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Telephone | 973-665-1782
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Fax | 973-635-7077
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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