Provider Demographics
NPI:1609910587
Name:NORFORD, BRADLEY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:C
Last Name:NORFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:SOUTHEASTERN
Mailing Address - State:PA
Mailing Address - Zip Code:19399-0893
Mailing Address - Country:US
Mailing Address - Phone:610-525-4828
Mailing Address - Fax:
Practice Address - Street 1:14 SOUTH BRYN MAWR AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-525-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006817103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
611267OtherHIGHMARK
611267OtherHIGHMARK