Provider Demographics
NPI:1194543355
Name:BRADLEY, SARAH (MSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 SUTTON PARK DR N APT 135
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2274
Mailing Address - Country:US
Mailing Address - Phone:813-545-2780
Mailing Address - Fax:
Practice Address - Street 1:13700 SUTTON PARK DR N APT 135
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2274
Practice Address - Country:US
Practice Address - Phone:813-545-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW196071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical