Provider Demographics
NPI:1629191549
Name:BRADBURY, IRENE ELIZABETH (MAED, MS)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:ELIZABETH
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:MAED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 TERESA CATHERINE WAY
Mailing Address - Street 2:APT. 202
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-0110
Mailing Address - Country:US
Mailing Address - Phone:727-459-8399
Mailing Address - Fax:
Practice Address - Street 1:4425 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3540
Practice Address - Country:US
Practice Address - Phone:727-638-6358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor