Basic Information
Provider Information
NPI: 1225378235
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEELE
FirstName: BRADFORD
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 8000
Address2: CALIFORNIA STATE PRISON - CORCORAN
City: CORCORAN
State: CA
PostalCode: 932128309
CountryCode: US
TelephoneNumber: 5599928800
FaxNumber: 5599927314
Practice Location
Address1: 4001 KING AVE.
Address2: CALIFORNIA STATE PRISON - CORCORAN
City: CORCORAN
State: CA
PostalCode: 932128309
CountryCode: US
TelephoneNumber: 5599928800
FaxNumber: 5599927314
Other Information
ProviderEnumerationDate: 02/28/2013
LastUpdateDate: 02/28/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPSY18183CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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