Brian William Bradley, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

868 Issued in WI

Practice address

101 Falls Rd
Suite 404
Grafton, WI 53024-2612

Phone

(262) 375-8441

Fax

(262) 546-0005

NPI assigned

Jan 2, 2007

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Adult Child & Family Services LLC

  • Adult Mental Health Clinic/Center
  • Grafton, WI
  • NPI 1578755237
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740347608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 FALLS RD",
            "address_2": "SUITE 404",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530242612",
            "telephone_number": "262-375-8441",
            "fax_number": "262-546-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FALLS RD",
            "address_2": "SUITE 404",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530242612",
            "telephone_number": "262-375-8441",
            "fax_number": "262-546-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "BRIAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY LICENSE NUMBER",
            "identifier": "868",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39050200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Francois Blumenfeld-Kouchner, D.O.
• Body Renovation Health Services, S.C.
• Body Renovation Physical Therapy SC
• Melinda C Bonilla-Puetz, MD
• Jacob Paul Boucher
• Andrew M Brand
• Caroline Marie Brandt, AGACNP-BC
• Allison Kimball Brown
• Kirk John Brown, M.D.
• Tamisha M Brown

• All providers in Grafton, WI
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.