Bradley R Holt, MA, MBA | |
175 King Of Prussia Rd, Radnor, PA 19087-4521 | |
(610) 644-6464 | |
(610) 981-6078 |
Full Name | Bradley R Holt |
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Gender | Male |
Speciality | Counselor - Professional |
Location | 175 King Of Prussia Rd, Radnor, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578997060 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
101YP2500X | Counselor - Professional | PC008645 (Pennsylvania) | Primary |
Entity Name | Brightside Medical Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508325184 PECOS PAC ID: 4082089461 Enrollment ID: O20230418000266 |
Mailing Address | Practice Location Address |
---|---|
Bradley R Holt, MA, MBA 680 American Ave, Suite 302, King Of Prussia, PA 19406-4023 Ph: (610) 644-6464 | Bradley R Holt, MA, MBA 175 King Of Prussia Rd, Radnor, PA 19087-4521 Ph: (610) 644-6464 |
Taylor Owens, MS,MFT Counselor Medicare: Not Enrolled in Medicare Practice Location: 320 King Of Prussia Rd Fl 2, Radnor, PA 19087 Phone: 484-654-2966 | |
Zoe Bianca Kahn, M.S., LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 King Of Prussia Rd Ste 650, Pmb # 7, Radnor, PA 19087 Phone: 484-254-6595 | |
Diana J Paisley, Counselor Medicare: Not Enrolled in Medicare Practice Location: 320 King Of Prussia Rd, Radnor, PA 19087 Phone: 610-527-9360 | |
Caroline M Hogan, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 175 King Of Prussia Rd, Radnor, PA 19087 Phone: 610-644-6464 Fax: 610-981-6078 | |
Lisa Mimmo, PSY.D Counselor Medicare: Not Enrolled in Medicare Practice Location: 320 King Of Prussia Rd, Radnor, PA 19087 Phone: 215-482-8000 | |
Dr. Shynita Dionne Rice, Counselor Medicare: Not Enrolled in Medicare Practice Location: Vicki Tornetta Counseling, Llc, 290 King Of Prussia Rd, Building 2, Suite 300, Radnor, PA 19087 Phone: 216-930-8002 | |
Ms. Ayana Wall, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 150 N Radnor Chester Rd Ste F200, Radnor, PA 19087 Phone: 610-977-2417 Fax: 610-977-0043 |