Provider Demographics
NPI:1073907721
Name:BRADLEY, KACYNTHIA GRACE (LMHC)
Entity Type:Individual
Prefix:
First Name:KACYNTHIA
Middle Name:GRACE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KACYNTHIA
Other - Middle Name:GRACE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, LMHC
Mailing Address - Street 1:914 HANCOCK STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233
Mailing Address - Country:US
Mailing Address - Phone:347-663-8261
Mailing Address - Fax:
Practice Address - Street 1:914 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1469
Practice Address - Country:US
Practice Address - Phone:347-663-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800104100000X
CT001030104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker