Provider Demographics
NPI:1184013732
Name:BRADFORD, CASEY BROWN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:BROWN
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2213
Mailing Address - Country:US
Mailing Address - Phone:310-486-6726
Mailing Address - Fax:
Practice Address - Street 1:1303 S LONGMORE STE 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9607
Practice Address - Country:US
Practice Address - Phone:480-712-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZ347103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst