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Individual

DR. BRADLEY WILLIAM SAMUEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
2400 TUCKER NE, ALBUQUERQUE, NM 87131-0001
(505) 272-1734
(505) 272-6308
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
738
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09702784
CO
05
955627
AZ
01
NM01JB06
BLUE SHIELD
NM
Enumeration date
07/07/2006
Last updated
05/22/2012
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