Provider Demographics
NPI:1659656528
Name:BRADLEY, TROY D II (MSW,LCSW)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:D
Last Name:BRADLEY
Suffix:II
Gender:M
Credentials:MSW,LCSW
Other - Prefix:MR
Other - First Name:TROY
Other - Middle Name:DONAVON
Other - Last Name:BRADLEY
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5225 CANYON CREST DR STE 103
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6353
Mailing Address - Country:US
Mailing Address - Phone:951-248-4000
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR STE 103
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6353
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750591041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health