Provider Demographics
NPI:1922265792
Name:BRADLEY, MARCIA E (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:E
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-2221
Mailing Address - Country:US
Mailing Address - Phone:508-758-3312
Mailing Address - Fax:
Practice Address - Street 1:92 GRAPE ST
Practice Address - Street 2:UNIT 1
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2143
Practice Address - Country:US
Practice Address - Phone:508-991-2332
Practice Address - Fax:508-991-8437
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA498366OtherTUFTS
MA00506196OtherASHA
MA0720054OtherMASSHEALTH
MA1922265792OtherBOSTON MEDICAL CENTER HEALTHNET PLAN
MAAA14788OtherHARVARD PILGRIM
MASP0291OtherBLUE CROSS BLUE SHIELD MASSACHUSETTS