Basic Information
| Provider Information | |||||||||
| NPI: | 1649476383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | MA, LMHC, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 REGIONAL DR STE 7 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 57 REGIONAL DR STE 7 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 01/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-06-2768 | MA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YM0800X | 1548 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.