Provider Demographics
NPI:1891230439
Name:BRADLEY, BLANCA F
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:F
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:FLORES
Other - Last Name:ESPINOSA MONTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 N BRAND BLVD FL 10
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1202
Mailing Address - Country:US
Mailing Address - Phone:818-524-8899
Mailing Address - Fax:
Practice Address - Street 1:700 N BRAND BLVD FL 10
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1202
Practice Address - Country:US
Practice Address - Phone:818-524-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW933531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical