Nicole Annette Bradley

Key facts

NPI

1700425980

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Analyst 103K00000X

License

2712338 (ME)

Practice address

50 Donald B Dean Dr Ste B
South Portland, ME 04106-3373

Phone

(207) 274-2528

NPI assigned

Jan 5, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 5, 2020.

{
    "created_epoch": "1578182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578182400000",
    "number": "1700425980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21600 OXNARD ST",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913674976",
            "telephone_number": "818-345-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 DONALD B DEAN DR STE B",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063373",
            "telephone_number": "207-274-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "NICOLE",
        "middle_name": "ANNETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-05",
        "last_updated": "2020-01-05",
        "certification_date": "2020-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "ME",
            "license": "2712338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in South Portland, ME · Behavior Analyst in Maine