Provider Demographics
NPI:1326264268
Name:GREENSPAN, BRADLEY MITCHELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MITCHELL
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1801
Mailing Address - Country:US
Mailing Address - Phone:267-574-1007
Mailing Address - Fax:
Practice Address - Street 1:1705 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1009
Practice Address - Country:US
Practice Address - Phone:215-860-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical