Individual
BRADLEY THOMAS MAYVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
(315) 946-7048
Mailing address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36560
NY
Other
Enumeration date
01/15/2021
Last updated
01/15/2021
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