Provider Demographics
NPI:1205140811
Name:BRADBURN, MICHAEL W (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BRADBURN
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 1:1819 BAY SCOTT CIR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1129
Mailing Address - Country:US
Mailing Address - Phone:630-357-2456
Mailing Address - Fax:630-357-2482
Practice Address - Street 1:1819 BAY SCOTT CIR
Practice Address - Street 2:SUITE 109
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1129
Practice Address - Country:US
Practice Address - Phone:630-357-2456
Practice Address - Fax:630-357-2482
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP1600X, 106H00000X
IL149.0083251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist