Provider Demographics
NPI:1649319799
Name:BRADSTREET, NANCY (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:BRADSTREET
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 WHITNEY AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518
Mailing Address - Country:US
Mailing Address - Phone:203-230-1774
Mailing Address - Fax:
Practice Address - Street 1:3208 WHITNEY AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-230-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00001521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PROVIDER #6259615OtherUNITED BEHAVIORAL HEALTH
11241384OtherCASH ID#
PIN #199570OtherMANAGED HEALTH NETWORK
134535OtherVALUE OPTIONS
PIN #0004619353OtherAETNA