Provider Demographics
NPI:1437613999
Name:WILLISON, BRADLEY STEVEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:STEVEN
Last Name:WILLISON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N VINE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2268
Mailing Address - Country:US
Mailing Address - Phone:520-982-6754
Mailing Address - Fax:
Practice Address - Street 1:502 N SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2626
Practice Address - Country:US
Practice Address - Phone:520-202-1716
Practice Address - Fax:520-202-1935
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-175671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical