Provider Demographics
NPI:1407109754
Name:HLAVACH, BRADLEY DURWIN
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DURWIN
Last Name:HLAVACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 PENN AVE
Mailing Address - Street 2:CHAMPION COMMONS BUILDING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224
Mailing Address - Country:US
Mailing Address - Phone:412-606-3389
Mailing Address - Fax:412-204-9103
Practice Address - Street 1:5231 PENN AVE
Practice Address - Street 2:CHAMPION COMMONS BUILDING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1768
Practice Address - Country:US
Practice Address - Phone:412-606-3389
Practice Address - Fax:412-204-9103
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health