Provider Demographics
NPI:1558008649
Name:BRADFORD L. STEVENS PSYCHOLOGY, P.C.
Entity Type:Organization
Organization Name:BRADFORD L. STEVENS PSYCHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-626-4364
Mailing Address - Street 1:300 E 75TH ST APT 20M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3377
Mailing Address - Country:US
Mailing Address - Phone:917-626-4364
Mailing Address - Fax:
Practice Address - Street 1:300 E 75TH ST APT 20M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3377
Practice Address - Country:US
Practice Address - Phone:917-626-4364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty