Individual
JOHNNIE A BRADFORD III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6940C 186TH LN APT 1C, FRESH MEADOWS, NY 11365-4411
(917) 435-8057
Mailing address
6940C 186TH LN APT 1C, FRESH MEADOWS, NY 11365-4411
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
12/26/2017
Last updated
12/26/2017
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