Provider Demographics
NPI:1871110221
Name:BRADLEY, JILLIAN L (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:L
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:200 MAY ST
Practice Address - Street 2:
Practice Address - City:S ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5520
Practice Address - Country:US
Practice Address - Phone:508-838-2219
Practice Address - Fax:508-838-2298
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328085363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health