Provider Demographics
NPI:1174965644
Name:BRADLEY, CHERYL ROBERTSON (LBS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ROBERTSON
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SKYLINE DR
Mailing Address - Street 2:SUITE 208 272
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1352
Mailing Address - Country:US
Mailing Address - Phone:201-921-4481
Mailing Address - Fax:
Practice Address - Street 1:1299 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-9116
Practice Address - Country:US
Practice Address - Phone:201-921-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA80-0941672103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst