Provider Demographics
NPI:1679583439
Name:BRADLEY, PATRICIA RAE (MSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:RAE
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 S ELIZABETH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1759
Mailing Address - Country:US
Mailing Address - Phone:816-373-7577
Mailing Address - Fax:816-373-9572
Practice Address - Street 1:3737 S ELIZABETH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1759
Practice Address - Country:US
Practice Address - Phone:816-373-7577
Practice Address - Fax:816-373-9572
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLCSW 0006631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical