Doctor Name: | DR. CARL E BRADFORD |
NPI Number: | 1194858639 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PS005598L |
Business Practice Address: | 146 Montgomery Ave Suite 302 Bala Cynwyd, PA - 190042956 |
Business Phone Number: | 6103169776 |
Business Fax Number: | 6106676421 |
Mailing Address: | 146 Montgomery Ave, Suite 302 BALA CYNWYD |
State: | PA |
Postal Code: | 190042956 |
Phone Number: | 6103169776 |
Fax Number: | 6106676421 |
NPI Enumeration Date: | 03/13/2007 |
NPI Last Update Date: | 07/16/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PS005598L |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |