Provider Demographics
NPI:1952477523
Name:BRADLEY-WINDELL, ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BRADLEY-WINDELL
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 1:23504 LYONS AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2500
Mailing Address - Country:US
Mailing Address - Phone:661-259-8200
Mailing Address - Fax:661-259-8419
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:661-259-8200
Practice Address - Fax:661-259-8419
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALC112501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical