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Octavia Bradley, BA
Professional Counselor in Maplewood, New Jersey
NPI 1417614447

Octavia Bradley is a Professional Counselor based in Maplewood, NJ and is specialized in Professional. Octavia Bradley practices in Maplewood, NJ and has the professional credentials of BA. The NPI Number for Octavia Bradley is 1417614447 and holds a License No. (New Jersey).

The current practice location address for Octavia Bradley is 2115 Millburn Ave Ste 104, Maplewood, NJ and can be reached out via phone at 973-850-9554.

Location: 2115 Millburn Ave Ste 104, Maplewood, NJ, 07040-3714
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1417614447
Provider Name
Octavia Bradley
Credential
BA
Provider Entity Type
Individual
Gender
Female
Address
2115 Millburn Ave Ste 104, Maplewood, NJ, 07040-3714
Phone Number
973-850-9554
Fax Number
Provider Enumeration Date
11/24/2021
Last Update Date
04/14/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
83-2600221 01 NJ TAX IDENTIFICATION NUMBER
832600221 01 NJ TAX IDENTIFICATION
institution
Provider Business Practice Location Address Details
Address
2115 Millburn Ave Ste 104
City
Maplewood
State
New Jersey
Zip
07040-3714
Phone Number
973-850-9554
Fax Number
person
Provider Business Mailing Address Details
Address
2115 Millburn Ave Ste 104
City
Maplewood
State
New Jersey
Zip
07040-3714
Phone Number
973-850-9554
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
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Definition
Definition to come...
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