Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 022131 | NY |
Y | 103T00000X | Psychologist | 022131 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 022131 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 022131 | NY |
N | 103G00000X | Clinical Psychologist | 022131 | NY |
N | 103TC0700X | Clinical Psychologist | 022131 | NY |
N | 103TC1900X | Counseling Psychologist | 022131 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 022131 | NY |
N | 103TF0000X | Family Psychologist | 022131 | NY |
N | 103TH0004X | Health Psychologist | 022131 | NY |
N | 103TH0100X | Health Service | 022131 | NY |
N | 103TS0200X | School Psychologist | 022131 | NY |
NPI | 1023530532 |
---|---|
Provider Name | Dr. Elizabeth G Bradley |
First Address | Albany, NY 12206-1415 |
Second Address | Albany, NY 12206-1415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 28/03/2019 |