Provider Demographics
NPI:1063948727
Name:AVERY, BRADLEY MARK (PHD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MARK
Last Name:AVERY
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:7789 ARUNDEL MILLS BLVD APT 542
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2028
Mailing Address - Country:US
Mailing Address - Phone:704-674-3751
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:704-674-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist