Provider Demographics
NPI:1861725442
Name:BRADBURY, NANCY CAROL (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CAROL
Last Name:BRADBURY
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:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92247-1114
Mailing Address - Country:US
Mailing Address - Phone:760-777-1902
Mailing Address - Fax:
Practice Address - Street 1:54835 AVENIDA HERRERA
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3778
Practice Address - Country:US
Practice Address - Phone:760-777-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical