Provider Demographics
NPI:1366792368
Name:BRADLEY, SCOTT W (MSW, CT, PSYA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MSW, CT, PSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2107
Mailing Address - Country:US
Mailing Address - Phone:973-665-1782
Mailing Address - Fax:973-635-7077
Practice Address - Street 1:19 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2107
Practice Address - Country:US
Practice Address - Phone:973-665-1782
Practice Address - Fax:973-635-7077
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst