Provider Demographics
NPI:1427542166
Name:BRADLEY-GILBERT, BRUCE (LMHC, ATR)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:BRADLEY-GILBERT
Suffix:
Gender:M
Credentials:LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3529
Mailing Address - Country:US
Mailing Address - Phone:413-320-7939
Mailing Address - Fax:
Practice Address - Street 1:35 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3035
Practice Address - Country:US
Practice Address - Phone:413-931-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3806101YM0800X
12301221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3806OtherLICENSED MENTAL HEALTH COUNSELOR (LMHC) MA
12301OtherAMERICAN ART THERAPY ASSOCIATION REGISTRATION