Provider Demographics
NPI:1437542255
Name:BRADFORD, ANDREA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 BAKERVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-510-2812
Mailing Address - Fax:
Practice Address - Street 1:2917 BAKERVIEW PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5789
Practice Address - Country:US
Practice Address - Phone:360-510-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604504581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical