Provider Demographics
NPI:1851484539
Name:BRADLEY, CECELIA FAYE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:FAYE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GLENDALE AVE
Mailing Address - Street 2:APT. 5
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511
Mailing Address - Country:US
Mailing Address - Phone:859-576-8090
Mailing Address - Fax:
Practice Address - Street 1:2909 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5044
Practice Address - Country:US
Practice Address - Phone:573-803-1402
Practice Address - Fax:573-803-1405
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0044641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical