Provider Demographics
NPI:1356803803
Name:BLOOMFIELD, BRADLEY SCOTT (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:BLOOMFIELD
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 COLONNADE PL APT 134
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2409
Mailing Address - Country:US
Mailing Address - Phone:631-790-3029
Mailing Address - Fax:
Practice Address - Street 1:4710 COLONNADE PL APT 134
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2409
Practice Address - Country:US
Practice Address - Phone:631-790-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2019-005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst