Provider Demographics
NPI:1760878334
Name:GROOVER, BRADLEY AARON (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:AARON
Last Name:GROOVER
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3457
Mailing Address - Country:US
Mailing Address - Phone:717-968-1976
Mailing Address - Fax:
Practice Address - Street 1:220 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3457
Practice Address - Country:US
Practice Address - Phone:717-968-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-09-6452103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst