Basic Information
| Provider Information | |||||||||
| NPI: | 1194858639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 564 | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190100564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842226467 | ||||||||
| FaxNumber: | 8564294755 | ||||||||
| Practice Location | |||||||||
| Address1: | 666 PLAINSBORO RD | ||||||||
| Address2: | |||||||||
| City: | PLAINSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085363030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442348387 | ||||||||
| FaxNumber: | 8564294755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 35SI00357900 | NJ | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | PS005598L | PA | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | 35SI00357900 | NJ | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PS005598L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.