Provider Demographics
NPI:1679825160
Name:BANCROFT, BRADFORD MANNING (MFT, RDT)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:MANNING
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:MFT, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1637
Mailing Address - Country:US
Mailing Address - Phone:818-415-2664
Mailing Address - Fax:
Practice Address - Street 1:208 S LOUISE ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1637
Practice Address - Country:US
Practice Address - Phone:818-415-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist