Provider Demographics
NPI:1356550701
Name:BRADLEY, ALAN EMMETT JR (LADC)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:EMMETT
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4509
Mailing Address - Country:US
Mailing Address - Phone:203-840-1483
Mailing Address - Fax:
Practice Address - Street 1:9 FAIR ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4509
Practice Address - Country:US
Practice Address - Phone:203-840-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000523101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor