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Individual
DR. MITCHELL JONATHAN BRADBURY
Active
Individual
DR. MITCHELL JONATHAN BRADBURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., PSYCHOLOGY
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
010694
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1048319
CIGNA
NY
01
—
5629606
AETNA PROVIDER ID
NY
01
—
74562
UHCUBH PROVIDER ID
NY
01
—
P1107568
OXFORD PROVIDER ID
NY
01
—
V90141
EBCBSNY PROVIDER ID
NY
Enumeration date
12/25/2006
Last updated
12/28/2022
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