Provider Demographics
NPI:1700042470
Name:BRADLEY, JOHN VINSON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINSON
Last Name:BRADLEY
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 1:408 AMQUIWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2657
Mailing Address - Country:US
Mailing Address - Phone:615-495-8780
Mailing Address - Fax:
Practice Address - Street 1:408 AMQUIWOOD CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2657
Practice Address - Country:US
Practice Address - Phone:615-495-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical