Provider Demographics
NPI:1588683809
Name:BRADLEY, KEVIN (LCSW, PC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:LCSW, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E HAWTHORN PKWY STE 336
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1467
Mailing Address - Country:US
Mailing Address - Phone:847-331-7907
Mailing Address - Fax:847-996-1033
Practice Address - Street 1:175 E HAWTHORN PKWY STE 336
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1467
Practice Address - Country:US
Practice Address - Phone:847-331-7907
Practice Address - Fax:847-996-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490094861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical