Provider Demographics
NPI:1093862617
Name:BRADLEY, ANN MARIE (ANN BRADLEY MSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:ANN BRADLEY MSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:17800 W PLEASANT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-8529
Mailing Address - Country:US
Mailing Address - Phone:734-416-3341
Mailing Address - Fax:734-416-3345
Practice Address - Street 1:190 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1236
Practice Address - Country:US
Practice Address - Phone:734-416-3341
Practice Address - Fax:734-416-3345
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010597361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical