Provider Demographics
NPI:1396874137
Name:STEVENS, BRADLEY REED
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:REED
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 E BACARRO ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HARBOR UCLA MEDICAL CENTER, 1000 W. CARSON ST
Practice Address - Street 2:2 SOUTH
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509-2004
Practice Address - Country:US
Practice Address - Phone:310-222-1648
Practice Address - Fax:310-222-5651
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA205981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical