Provider Demographics
NPI:1982346557
Name:JONES, BRADLEY ELLIOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ELLIOTT
Last Name:JONES
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:PO BOX 66700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-0700
Mailing Address - Country:US
Mailing Address - Phone:925-683-3023
Mailing Address - Fax:
Practice Address - Street 1:2207 PELHAM AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2006
Practice Address - Country:US
Practice Address - Phone:925-683-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-06-03
Deactivation Date:2022-04-12
Deactivation Code:
Reactivation Date:2022-06-03
Provider Licenses
StateLicense IDTaxonomies
CA815361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical