Provider Demographics
NPI:1679807499
Name:NYMAN, BRAD K (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:K
Last Name:NYMAN
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 1:7355 CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3273
Mailing Address - Country:US
Mailing Address - Phone:949-294-8627
Mailing Address - Fax:
Practice Address - Street 1:7355 CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3273
Practice Address - Country:US
Practice Address - Phone:949-294-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-06721101YP2500X
NMI-07957101YP2500X
CALCSW632801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA136275Medicaid