Provider Demographics
NPI:1679748826
Name:MADREPERL, BRADFORD LOUIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:LOUIS
Last Name:MADREPERL
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 1:45 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6720
Mailing Address - Country:US
Mailing Address - Phone:732-229-0800
Mailing Address - Fax:732-229-0800
Practice Address - Street 1:45 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6720
Practice Address - Country:US
Practice Address - Phone:732-229-0800
Practice Address - Fax:732-229-0800
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000324001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical