Provider Demographics
NPI:1659518538
Name:APPLEGATE, BRADFORD WEST (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:WEST
Last Name:APPLEGATE
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 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:571-209-5905
Mailing Address - Fax:
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:571-209-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical