Provider Demographics
NPI:1831462001
Name:MIDGETT, BRADLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:MIDGETT
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 1:8590 W FAIRVIEW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8320
Mailing Address - Country:US
Mailing Address - Phone:208-559-3319
Mailing Address - Fax:
Practice Address - Street 1:8590 W FAIRVIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8320
Practice Address - Country:US
Practice Address - Phone:208-672-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW301201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical