1396899761 NPI number — MS. LUCY CLARE BRADFORD LICSW

Table of content: MS. LUCY CLARE BRADFORD LICSW (NPI 1396899761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396899761 NPI number — MS. LUCY CLARE BRADFORD LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADFORD
Provider First Name:
LUCY
Provider Middle Name:
CLARE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396899761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARPERS FERRY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25425-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-535-1910
Provider Business Mailing Address Fax Number:
304-535-1943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLIVAR
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25425-0490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-535-1910
Provider Business Practice Location Address Fax Number:
304-535-1943
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)