Provider Demographics
NPI:1972882496
Name:BRADLEY, PETER H (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:BRADLEY
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 1:501 28TH ST
Mailing Address - Street 2:EASTSIDE HEALTH
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3003
Mailing Address - Country:US
Mailing Address - Phone:303-436-4618
Mailing Address - Fax:303-436-4779
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 1700, DENVER HEALTH MEDICAL CENTER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-4618
Practice Address - Fax:303-436-4779
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9897081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical