Provider Demographics
NPI:1154750248
Name:BEZILLA, BRADLEY SCOTT (BCBA)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:BEZILLA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 FORSYTH PARK ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6682
Mailing Address - Country:US
Mailing Address - Phone:919-999-0276
Mailing Address - Fax:
Practice Address - Street 1:640 TIMBER DR E STE 120
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7883
Practice Address - Country:US
Practice Address - Phone:919-999-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst