Provider Demographics
NPI:1124411640
Name:BRADLEY, ANNE (LGSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E ST NE
Mailing Address - Street 2:APT. 202
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5247
Mailing Address - Country:US
Mailing Address - Phone:228-806-4916
Mailing Address - Fax:
Practice Address - Street 1:1443 EUCLID ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4506
Practice Address - Country:US
Practice Address - Phone:202-285-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-08
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50080884104100000X
MD20416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker