Provider Demographics
NPI:1295120491
Name:BRADLEY, ELISE BALDWIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:BALDWIN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4653 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE 308 #232
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-314-8335
Mailing Address - Fax:
Practice Address - Street 1:12526 HIGH BLUFF DRIVE SUITE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-314-8335
Practice Address - Fax:855-706-2056
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNP0000003132103G00000X, 103TC0700X
CA32335103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical