Provider Demographics
NPI:1497094098
Name:MCCALLISTER, BRADLEY (MS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3011
Mailing Address - Country:US
Mailing Address - Phone:304-412-4514
Mailing Address - Fax:
Practice Address - Street 1:701 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5818
Practice Address - Country:US
Practice Address - Phone:215-643-7676
Practice Address - Fax:215-542-9219
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral