Provider Demographics
NPI:1154099836
Name:BRADLEY, WENDY (MS, ATR-BC, CLAT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS, ATR-BC, CLAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BRADFORD CORNER RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK VALLEY
Mailing Address - State:CT
Mailing Address - Zip Code:06282-2004
Mailing Address - Country:US
Mailing Address - Phone:860-933-5530
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST STE 1303
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2701
Practice Address - Country:US
Practice Address - Phone:860-933-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTART.000012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health