Provider Demographics
NPI:1790547560
Name:BRADFORD, THEMA (LMHC)
Entity Type:Individual
Prefix:
First Name:THEMA
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 FLATBUSH AVE APT A1209
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-9023
Mailing Address - Country:US
Mailing Address - Phone:347-683-1490
Mailing Address - Fax:
Practice Address - Street 1:551 CHAUNCEY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-5871
Practice Address - Country:US
Practice Address - Phone:718-775-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health