Provider Demographics
NPI:1609479781
Name:BRADNI, RAYMOND ABRAHAM (PSYCHOLOGIST PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ABRAHAM
Last Name:BRADNI
Suffix:
Gender:M
Credentials:PSYCHOLOGIST PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 HUNTERS BRANCH RD UNIT 125
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-6066
Mailing Address - Country:US
Mailing Address - Phone:559-917-3736
Mailing Address - Fax:
Practice Address - Street 1:5244 LYNGATE CT # 200
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1631
Practice Address - Country:US
Practice Address - Phone:703-537-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical