Provider Demographics
NPI:1821709155
Name:DUFF, BRADLY ROWAN
Entity Type:Individual
Prefix:
First Name:BRADLY
Middle Name:ROWAN
Last Name:DUFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2313
Mailing Address - Country:US
Mailing Address - Phone:513-847-4685
Mailing Address - Fax:513-847-4763
Practice Address - Street 1:7413 SQUIRE CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2313
Practice Address - Country:US
Practice Address - Phone:513-847-4685
Practice Address - Fax:513-847-4763
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
OHRBT-22-240127106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
997266503OtherUNITED HEALTH CARE