Provider Demographics
NPI:1205558640
Name:SAMAVATI, BRADLEY A (LMSW)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:SAMAVATI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N LOOP 1604 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1450
Mailing Address - Country:US
Mailing Address - Phone:210-761-3504
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:227 N LOOP 1604 E STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1450
Practice Address - Country:US
Practice Address - Phone:210-761-3504
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician