Bradley, Octavia

Bradley, Octavia is an sole proprietor health care provider with primary practice located at 2115 Millburn Ave Ste 104 , Maplewood NJ 07040-3714. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Bradley, Octavia can be contacted via phone (973) 850-9554.

Contact Information

Primary practice address
2115 Millburn Ave Ste 104 Maplewood NJ 07040-3714
Phone: (973) 850-9554
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X

Profile Details

NPI number 1417614447
LBN Legal business name Bradley, Octavia
Credentials Bachelor of Arts (BA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 24th, 2021
Last updated Mar 20th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417614447 NPPES
New Jersey Other 83-2600221 TAX IDENTIFICATION NUMBER
New Jersey Other 832600221 TAX IDENTIFICATION NUMBER

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