Provider Demographics
NPI:1215340773
Name:CARROLL, BRADLEY (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8591 HOLLY MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-8604
Mailing Address - Country:US
Mailing Address - Phone:304-478-3339
Mailing Address - Fax:
Practice Address - Street 1:8591 HOLLY MEADOWS RD
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-8604
Practice Address - Country:US
Practice Address - Phone:304-478-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WV2012-2932225700000X
MDM04990225700000X
WVBP009470331041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist