Active NPI
Mitchell Jonathan Bradbury, PH.D., PSYCHOLOGY
- Clinical Psychologist
- Scarsdale, NY
National Provider Identifier
1154486843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010694
- Practice address
- 14 Harwood CT Ste 213
Scarsdale, NY 10583-4120 - Phone
- (917) 751-1868
- NPI assigned
- Dec 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 010694 | NY | Primary |
Addresses
Primary practice location
14 Harwood CT Ste 213
Scarsdale, NY 10583-4120
Mailing address
14 Harwood CT Ste 213
Scarsdale, NY 10583-4120
Phone (917) 751-1868
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74562 | Other | NY | UHCUBH PROVIDER ID |
| P1107568 | Other | NY | OXFORD PROVIDER ID |
| 1048319 | Other | NY | CIGNA |
| 5629606 | Other | NY | AETNA PROVIDER ID |
| V90141 | Other | NY | EBCBSNY PROVIDER ID |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010694 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672185600000",
"number": "1154486843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 HARWOOD CT STE 213",
"city": "SCARSDALE",
"state": "NY",
"postal_code": "105834120",
"telephone_number": "917-751-1868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 HARWOOD CT STE 213",
"city": "SCARSDALE",
"state": "NY",
"postal_code": "105834120",
"telephone_number": "917-751-1868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADBURY",
"first_name": "MITCHELL",
"middle_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "PH.D., PSYCHOLOGY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-25",
"last_updated": "2022-12-28",
"certification_date": "2022-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010694",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHCUBH PROVIDER ID",
"identifier": "74562",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD PROVIDER ID",
"identifier": "P1107568",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1048319",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER ID",
"identifier": "5629606",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EBCBSNY PROVIDER ID",
"identifier": "V90141",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scarsdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.