Provider Demographics
NPI:1922407337
Name:BRADLEY, KIMBERLY ANNETTE (BSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10844 VICENZA DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5279
Mailing Address - Country:US
Mailing Address - Phone:505-249-5398
Mailing Address - Fax:505-271-4957
Practice Address - Street 1:10844 VICENZA DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5279
Practice Address - Country:US
Practice Address - Phone:505-249-5398
Practice Address - Fax:505-271-4957
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical