Provider Demographics
NPI:1396899761
Name:BRADFORD, LUCY CLARE (LICSW)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:CLARE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LICSW
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 490
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-0490
Mailing Address - Country:US
Mailing Address - Phone:304-535-1910
Mailing Address - Fax:304-535-1943
Practice Address - Street 1:1441 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:WV
Practice Address - Zip Code:25425-0490
Practice Address - Country:US
Practice Address - Phone:304-535-1910
Practice Address - Fax:304-535-1943
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor