Provider Demographics
NPI:1033503644
Name:RADFORD, WILLA (CASAC)
Entity Type:Individual
Prefix:
First Name:WILLA
Middle Name:
Last Name:RADFORD
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:WILLA
Other - Middle Name:
Other - Last Name:RADFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:340 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1963
Mailing Address - Country:US
Mailing Address - Phone:718-346-5900
Mailing Address - Fax:718-498-1718
Practice Address - Street 1:510 GATES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1506
Practice Address - Country:US
Practice Address - Phone:718-346-5900
Practice Address - Fax:718-498-1718
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)