Provider Demographics
NPI:1659097285
Name:BRADLEY, ADESTELA (MSED)
Entity Type:Individual
Prefix:
First Name:ADESTELA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10831 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4715
Mailing Address - Country:US
Mailing Address - Phone:754-202-0075
Mailing Address - Fax:
Practice Address - Street 1:1535 N PARK DR STE 103
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3226
Practice Address - Country:US
Practice Address - Phone:754-202-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health