NPIMap

Organization Active NPI

Jennifer K Bradley, PSYD LLC

  • Psychologist
  • Tempe, AZ
National Provider Identifier
1174071963
Registry record updated Sep 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3451 Issued in AZ
Legal business name
JENNIFER K BRADLEY, PSYD LLC
Practice address
4500 S Lakeshore Dr
Ste 345
Tempe, AZ 85282-7052
Phone
(480) 917-3255
Fax
(480) 838-9022
NPI assigned
Sep 21, 2016
Last updated
Sep 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer K Bradley, PSYDNPI 1386765550
Title
Clinical Psychologist
Phone
(480) 917-3255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 3451 AZ Primary

Addresses

Primary practice location

4500 S Lakeshore Dr
Ste 345
Tempe, AZ 85282-7052

Mailing address

4500 S Lakeshore Dr
Ste 345
Tempe, AZ 85282-7052
Phone (480) 917-3255

National Provider Directory

National Provider Directory

Locations

4500 S Lakeshore Dr
Ste 345
Tempe, AZ 85282
Phone (480) 917-3255

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1174071963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S LAKESHORE DR",
            "address_2": "STE 345",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827052",
            "telephone_number": "480-917-3255",
            "fax_number": "480-838-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 S LAKESHORE DR",
            "address_2": "STE 345",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827052",
            "telephone_number": "480-917-3255",
            "fax_number": "480-838-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER K BRADLEY, PSYD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "480-917-3255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "3451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.