Provider Demographics
NPI:1558024877
Name:BRADLEY, JOHN F
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 TRANSPORTATION BLVD STE 22
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5307
Mailing Address - Country:US
Mailing Address - Phone:216-677-4673
Mailing Address - Fax:216-865-6050
Practice Address - Street 1:5350 TRANSPORTATION BLVD STE 22
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5307
Practice Address - Country:US
Practice Address - Phone:216-677-4673
Practice Address - Fax:216-865-6050
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.177946101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.177946OtherCDCA