Provider Demographics
NPI:1174855993
Name:BRADBERRY, ANGELA CHRIS (M ED)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRIS
Last Name:BRADBERRY
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TOURNAMENT RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3647
Mailing Address - Country:US
Mailing Address - Phone:904-651-3660
Mailing Address - Fax:
Practice Address - Street 1:406 TOURNAMENT RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3647
Practice Address - Country:US
Practice Address - Phone:904-280-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst