Provider Demographics
NPI:1316126659
Name:BRADLEY, CRYSTAL MARIE (NCC)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 LEXINGTON AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1175
Mailing Address - Country:US
Mailing Address - Phone:347-853-3027
Mailing Address - Fax:
Practice Address - Street 1:315 HUDSON ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1040
Practice Address - Country:US
Practice Address - Phone:212-366-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)