| 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 | 
|---|---|
| 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 | 
|---|---|
| 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  | |
Jibri Aswad Mclean, M.S., LAPC, NCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 150 N Radnor Chester Rd Ste F200, Radnor, PA 19087 Phone: 267-587-6722  |