Provider Demographics
NPI:1720001670
Name:BRADFORD, JUDITH ALICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ALICIA
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E. LOOCKERMAN ST.
Mailing Address - Street 2:TREADWAY TOWERS
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-678-7866
Mailing Address - Fax:302-678-7866
Practice Address - Street 1:9 E. LOOCKERMAN ST.
Practice Address - Street 2:TREADWAY TOWERS
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-678-7866
Practice Address - Fax:302-678-7866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100003831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE019198K40Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID