Brian David Bradley

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006993 Issued in MI

Practice address

30200 Telegraph Rd
Suite 207
Bingham Farms, MI 48025-4502

Phone

(248) 712-1129

Fax

(248) 569-9410

NPI assigned

Jul 20, 2014

Last updated

Aug 9, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1405814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407542400000",
    "number": "1619384815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4217 ARLINGTON DR",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736305",
            "telephone_number": "248-761-9679",
            "fax_number": "248-569-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30200 TELEGRAPH RD",
            "address_2": "SUITE 207",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254502",
            "telephone_number": "248-712-1129",
            "fax_number": "248-569-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "BRIAN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-20",
        "last_updated": "2014-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006993",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "MI",
            "license": "CC-0C3110345997",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Marie Boyles, CRNA
• Kierra Cea Bozeman
• Anthony Jacob Bracey
• Lacrista Sharmeail Bracey
• Asia Bradley
• Dana Maria Bradley
• Deloris Michelle Bradley
• Brain Injury Diagnostic Centers
• Isabella Caterina Brandow
• Rachel Anita Brantley

• Clinical Psychologist in Bingham Farms, MI
• Providers in Bingham Farms, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2014; 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.