Provider Demographics
NPI:1770829038
Name:LEARY, BRADFORD VINCENT (LCSW)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:VINCENT
Last Name:LEARY
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 1:1053 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3507
Mailing Address - Country:US
Mailing Address - Phone:650-245-5367
Mailing Address - Fax:
Practice Address - Street 1:1053 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3507
Practice Address - Country:US
Practice Address - Phone:650-245-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS248871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical