Provider Demographics
NPI:1609012947
Name:CHRISTENSEN, BRADLEY (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4025
Mailing Address - Country:US
Mailing Address - Phone:973-229-6804
Mailing Address - Fax:
Practice Address - Street 1:30 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4025
Practice Address - Country:US
Practice Address - Phone:201-431-5707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00402300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional