Provider Demographics
NPI:1538808555
Name:BRADLEY, CASSIDY BROOKE (BCBA)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:BROOKE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:BROOKE
Other - Last Name:SEYFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9601 BUSTLETON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3810
Mailing Address - Country:US
Mailing Address - Phone:856-346-0005
Mailing Address - Fax:
Practice Address - Street 1:9601 BUSTLETON AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3810
Practice Address - Country:US
Practice Address - Phone:856-346-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-63474103K00000X
PABH005632103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst