Provider Demographics
NPI:1548512577
Name:MACNEIL, BRADLY ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:BRADLY
Middle Name:ANDREW
Last Name:MACNEIL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12403 W MORNING VISTA LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2456
Mailing Address - Country:US
Mailing Address - Phone:703-587-3084
Mailing Address - Fax:
Practice Address - Street 1:12403 W MORNING VISTA LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2456
Practice Address - Country:US
Practice Address - Phone:703-587-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4359103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent