Active NPI
Bradley John Crenshaw, PH.D.
- Clinical Neuropsychologist
- Amherst, MA
National Provider Identifier
1215994207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 6679
- Practice address
- 79 S Pleasant St
Suite 6
Amherst, MA 01002-2370 - Phone
- (413) 259-1017
- Fax
- (413) 259-1017
- NPI assigned
- Apr 26, 2006
- Sex
- Male
- Sole proprietor
- No
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 Neuropsychologist | 103G00000X | 6679 | MA | Primary |
Addresses
Primary practice location
79 S Pleasant St
Suite 6
Amherst, MA 01002-2370
Mailing address
20 Maplewood Dr
Amherst, MA 01002-1843
Phone (413) 549-4146
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0526886 | Medicaid | MA | |
| 24757 | Other | MA | HEALTH NEW ENGLAND |
| W05830 | Other | MA | BLUE CROSS/BLUE SHIELD |
| 62000574 | Other | MA | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| 6679 | MA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229040000000",
"number": "1215994207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 MAPLEWOOD DR",
"city": "AMHERST",
"state": "MA",
"postal_code": "010021843",
"telephone_number": "413-549-4146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 S PLEASANT ST",
"address_2": "SUITE 6",
"city": "AMHERST",
"state": "MA",
"postal_code": "010022370",
"telephone_number": "413-259-1017",
"fax_number": "413-259-1017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRENSHAW",
"first_name": "BRADLEY",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2008-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "6679",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0526886",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NEW ENGLAND",
"identifier": "24757",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "W05830",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "62000574",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amherst, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.