Provider Demographics
NPI:1740551332
Name:BRADT-HYLAND, CHERYL (LCAT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BRADT-HYLAND
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-1102
Mailing Address - Country:US
Mailing Address - Phone:518-788-7894
Mailing Address - Fax:
Practice Address - Street 1:21 AVIATION RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1141
Practice Address - Country:US
Practice Address - Phone:518-788-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000920-1101Y00000X
NY11448101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)