Provider Demographics
NPI:1891839023
Name:HESS, BRADLEY STEVEN
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:STEVEN
Last Name:HESS
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 1:6745 BIRCHMAN DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3171
Mailing Address - Country:US
Mailing Address - Phone:310-544-1260
Mailing Address - Fax:
Practice Address - Street 1:6745 BIRCHMAN DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3171
Practice Address - Country:US
Practice Address - Phone:310-544-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist