Basic Information
| Provider Information | |||||||||
| NPI: | 1255483210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWELL | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WELLAND RD | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021882213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813318708 | ||||||||
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| Practice Location | |||||||||
| Address1: | 460 QUINCY AVE | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021698130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178471950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3077 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.