Provider Demographics
NPI:1609979608
Name:BRADFORD C. RICHARDS
Entity Type:Organization
Organization Name:BRADFORD C. RICHARDS
Other - Org Name:COGNITIVE BEHAVIORAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-823-1600
Mailing Address - Street 1:1 SAN RAFAEL AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122
Mailing Address - Country:US
Mailing Address - Phone:505-823-1600
Mailing Address - Fax:505-823-1161
Practice Address - Street 1:1 SAN RAFAEL AVENUE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122
Practice Address - Country:US
Practice Address - Phone:505-823-1600
Practice Address - Fax:505-823-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSYCHOLOGIST #0855261QM0801X
NM#0855261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2473804Medicaid
NM24738034Medicaid
NM24738034Medicaid
339436301Medicare PIN
NM2473804Medicaid