Individual
MR. BRADLEY S WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 W GEORGE ST, CARMICHAELS, PA 15320-1325
(724) 966-5081
(724) 966-2414
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440093
—
PA
01
—
328834A764918
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
09/27/2012
Last updated
09/27/2012
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