Provider Demographics
NPI:1619731197
Name:BRADIS, COURTNEY ANNE (LMFT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE
Last Name:BRADIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 JOHN F KENNEDY BLVD STE 1406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7437
Mailing Address - Country:US
Mailing Address - Phone:267-341-7224
Mailing Address - Fax:
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD STE 1406
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7437
Practice Address - Country:US
Practice Address - Phone:267-341-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist