Provider Demographics
NPI:1457347734
Name:BRADFORD, DEANNA LYNN (LCSW-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:BRADFORD
Suffix:
Gender:
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1219
Mailing Address - Country:US
Mailing Address - Phone:443-235-4122
Mailing Address - Fax:410-352-5735
Practice Address - Street 1:401 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:WHALEYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21872-2114
Practice Address - Country:US
Practice Address - Phone:443-235-4122
Practice Address - Fax:410-352-5735
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413773600Medicaid