Provider Demographics
NPI:1891851069
Name:TEPASKE, BRADLEY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:TEPASKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16833 GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2260
Mailing Address - Country:US
Mailing Address - Phone:310-459-8364
Mailing Address - Fax:
Practice Address - Street 1:16833 GLYNN DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2260
Practice Address - Country:US
Practice Address - Phone:310-459-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical