NPIMap

Individual provider Active NPI

Jennifer Kay Bradley, PSY.D.

  • Clinical Psychologist
  • Tempe, AZ
National Provider Identifier
1386765550
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3451 Issued in AZ
Practice address
4500 S Lakeshore Dr
Ste 300
Tempe, AZ 85282-7028
Phone
(480) 379-2489
Fax
(480) 345-2126
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3451 AZ Primary

Addresses

Primary practice location

4500 S Lakeshore Dr
Ste 300
Tempe, AZ 85282-7028

Mailing address

4500 S Lakeshore Dr
Ste 300
Tempe, AZ 85282-7028
Phone (480) 379-2489

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

Practice roles

OrganizationSpecialtyStatusNew patients
Diane Park MD LLC Past Accepting new patients
Heal Az Counseling and Wellness Center PLLC Clinical Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1386765550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S LAKESHORE DR",
            "address_2": "STE 300",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827028",
            "telephone_number": "480-379-2489",
            "fax_number": "480-345-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 S LAKESHORE DR",
            "address_2": "STE 300",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827028",
            "telephone_number": "480-379-2489",
            "fax_number": "480-345-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "JENNIFER",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "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 Jun 30, 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.