Provider Demographics
NPI:1124457528
Name:BRADLEY, JANET LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 HOMELAND SOUTHWAY
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4165
Mailing Address - Country:US
Mailing Address - Phone:240-461-8436
Mailing Address - Fax:
Practice Address - Street 1:331 HOMELAND SOUTHWAY
Practice Address - Street 2:UNIT 1B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4165
Practice Address - Country:US
Practice Address - Phone:240-461-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional