Provider Demographics
NPI:1578981031
Name:BRADLEY, LYNDA
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:EASLEY
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:223 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1423
Mailing Address - Country:US
Mailing Address - Phone:724-809-7994
Mailing Address - Fax:724-852-6313
Practice Address - Street 1:95 E HIGH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1853
Practice Address - Country:US
Practice Address - Phone:724-627-4692
Practice Address - Fax:724-852-6313
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100772109Medicaid