Provider Demographics
NPI:1831325885
Name:BRADLEY, MARGO CATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:CATHERINE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:585-957-0272
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNETT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-1784
Practice Address - Fax:315-636-1336
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047371041C0700X
OHI.13026461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical