Octavia Bradley, BA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

2115 Millburn Ave Ste 104
Maplewood, NJ 07040-3714

Phone

(973) 850-9554

NPI assigned

Nov 24, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

Locations

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.

• Reveal 2 Heal Consulting Services LLC

  • Clinical Social Worker
  • Maplewood, NJ
  • NPI 1306471016
  NPD Authorized official
• Reveal to Heal Consulting a NJ Non Profit

  • Mental Health Occupational Therapist
  • Maplewood, NJ
  • NPI 1386491355
  NPD Authorized official

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

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1417614447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 MILLBURN AVE STE 104",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403714",
            "telephone_number": "973-850-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 MILLBURN AVE STE 104",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403714",
            "telephone_number": "973-850-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "OCTAVIA",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-24",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "83-2600221",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "832600221",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "octavia@reveal2healconsulting.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2115 Millburn Ave Ste 104",
            "city": "Maplewood",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "070403714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laura Christine Booker, LCSW
• Jessica Boram Charkow
• Sonal Bordia
• Jaclyn Borrone, M.A.
• Bowman and Brown Consulting, L.L.C
• Sally Beth Bregman, O.D.
• Bridging Inclusive Connections, LLC
• Bridging Inclusive Connections, LLC
• Ausma Briedis, OT
• Sara Elizabeth Brinkerhoff, LSW

• Professional Counselor in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.