Provider Demographics
NPI:1003253402
Name:BRADT, KAREN E
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:BRADT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S BEACH ST
Mailing Address - Street 2:SUITE 101 3N
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5079
Mailing Address - Country:US
Mailing Address - Phone:386-310-3646
Mailing Address - Fax:
Practice Address - Street 1:340 S BEACH ST
Practice Address - Street 2:SUITE 101 3N
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5079
Practice Address - Country:US
Practice Address - Phone:386-310-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW67161041C0700X
FLSW114491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical