Provider Demographics
NPI:1982698098
Name:BRADLEY, WILLIAM LOWELL (MSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LOWELL
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E BROADWAY RD
Mailing Address - Street 2:#25
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1879
Mailing Address - Country:US
Mailing Address - Phone:480-921-3711
Mailing Address - Fax:480-921-0307
Practice Address - Street 1:2101 E BROADWAY RD
Practice Address - Street 2:#25
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1879
Practice Address - Country:US
Practice Address - Phone:480-921-3711
Practice Address - Fax:480-921-0307
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 0107I1041C0700X
AZLMFT-0085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist