Provider Demographics
NPI:1689148934
Name:BRADLEY, TIFFANY M
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W 140TH ST APT 8B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1967
Mailing Address - Country:US
Mailing Address - Phone:929-287-9055
Mailing Address - Fax:
Practice Address - Street 1:275 W 140TH ST APT 8B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1967
Practice Address - Country:US
Practice Address - Phone:929-287-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker