Provider Demographics
NPI:1437243342
Name:ABBEY BRADWAY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ABBEY BRADWAY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:856-696-5690
Mailing Address - Street 1:2630 E CHESTNUT AVE
Mailing Address - Street 2:D-4
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8400
Mailing Address - Country:US
Mailing Address - Phone:856-696-5690
Mailing Address - Fax:856-696-4799
Practice Address - Street 1:2630 E CHESTNUT AVE
Practice Address - Street 2:D-4
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8400
Practice Address - Country:US
Practice Address - Phone:856-696-5690
Practice Address - Fax:856-696-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00054400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty