Provider Demographics
NPI:1972671261
Name:BRADLEY, STEPHEN JAMES (LICSW, LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAMES
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:LICSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:HAYDENVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01039-0914
Mailing Address - Country:US
Mailing Address - Phone:413-522-0838
Mailing Address - Fax:
Practice Address - Street 1:8 TRUMBULL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3079
Practice Address - Country:US
Practice Address - Phone:413-588-8423
Practice Address - Fax:888-981-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4592101YM0800X
MA1174051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health