Provider Demographics
NPI:1104973528
Name:BRADLEY, JEANETTE MARGARET (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:MARGARET
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:BRADLEY
Other - Last Name:ISAKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3550 WATT AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821
Mailing Address - Country:US
Mailing Address - Phone:916-977-0885
Mailing Address - Fax:916-442-7656
Practice Address - Street 1:3550 WATT AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-977-0885
Practice Address - Fax:916-442-7656
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS109601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS10960OtherBOARD OF BEHAV SCIENCES