Provider Demographics
NPI:1417359373
Name:BRADLEY, MOLLY (LMSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:SCHOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 E AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2100
Mailing Address - Country:US
Mailing Address - Phone:316-775-5491
Mailing Address - Fax:
Practice Address - Street 1:2821 BROOKSIDE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2433
Practice Address - Country:US
Practice Address - Phone:316-425-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KS9959104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker