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CLIENT CONTACT INFORMATION SHEET Carl E Bradford, PhD(610) 3169776 drbradford@bradfordneuropsych.comBirth Date: ___/___/___ Age:___ Gender: Male Female Name:___ Address (Street and Number):___ City:
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Carl Bradford Phdtelehealth Psychoformrapypennsylvania is a form or document related to the telehealth psychotherapy services provided by Dr. Carl Bradford in Pennsylvania.
Any individual or organization offering telehealth psychotherapy services in Pennsylvania, specifically those provided by Dr. Carl Bradford, may be required to file the form.
The form can be filled out by providing all the necessary information related to the telehealth psychotherapy services offered by Dr. Carl Bradford in Pennsylvania.
The purpose of the form is to report and document the telehealth psychotherapy services provided by Dr. Carl Bradford in Pennsylvania.
The form may require information such as the types of telehealth psychotherapy services offered, number of patients served, duration of sessions, fees charged, and any other relevant details.
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