Provider Demographics
NPI:1477642478
Name:BRADLEY, ADELE VICTORIA (LCMHC)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:VICTORIA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLOSS LN
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2632
Mailing Address - Country:US
Mailing Address - Phone:603-497-2410
Mailing Address - Fax:603-497-2410
Practice Address - Street 1:10 PLOSS LN
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2632
Practice Address - Country:US
Practice Address - Phone:603-497-2410
Practice Address - Fax:603-497-2410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14YOO1384NH01OtherANTHEM BC/BS PIN