Provider Demographics
NPI:1417960592
Name:PRICE, JOHN BRADFORD (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADFORD
Last Name:PRICE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BAHAMA BND
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3219
Mailing Address - Country:US
Mailing Address - Phone:858-220-6833
Mailing Address - Fax:
Practice Address - Street 1:8023 PSC
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28533-8000
Practice Address - Country:US
Practice Address - Phone:858-220-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1482103TC0700X
CAPSY35292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical