Active NPI
Kathryn R Bradbury, PHD
- Clinical Psychologist
- Andover, MA
National Provider Identifier
1104424407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 11369
- Practice address
- 26 Chestnut St Ste 2E
Andover, MA 01810-3600 - Phone
- (978) 749-2700
- NPI assigned
- Oct 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3279 | OR | |
| Clinical Psychologist | 103TC0700X | 11369 | MA | Primary |
Addresses
Primary practice location
26 Chestnut St Ste 2E
Andover, MA 01810-3600
Mailing address
200 Presidential Way Unit 2418
Woburn, MA 01801-0068
Phone (860) 965-1775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11369 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602201600000",
"number": "1104424407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 PRESIDENTIAL WAY UNIT 2418",
"city": "WOBURN",
"state": "MA",
"postal_code": "018010068",
"telephone_number": "860-965-1775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 CHESTNUT ST STE 2E",
"city": "ANDOVER",
"state": "MA",
"postal_code": "018103600",
"telephone_number": "978-749-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADBURY",
"first_name": "KATHRYN",
"middle_name": "R",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-09",
"last_updated": "2020-10-09",
"certification_date": "2020-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3279",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "11369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.