Provider Demographics
NPI:1093388522
Name:BRADLEY, TIMOTHY M (MSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 ABBOTT RD UNIT 500
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1069
Mailing Address - Country:US
Mailing Address - Phone:716-822-2117
Mailing Address - Fax:716-822-8165
Practice Address - Street 1:3176 ABBOTT RD UNIT 500
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1069
Practice Address - Country:US
Practice Address - Phone:716-822-2117
Practice Address - Fax:716-822-6185
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)