Provider Demographics
NPI:1194170712
Name:BRADLEY, SUSAN (BCBA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-0329
Mailing Address - Country:US
Mailing Address - Phone:229-563-5439
Mailing Address - Fax:
Practice Address - Street 1:1951 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-0329
Practice Address - Country:US
Practice Address - Phone:229-563-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst