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NPI Code Detail

MEDICARE: BRADLEY YOUNGBLOOD MSSW

MEDICARE: BRADLEY YOUNGBLOOD MSSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1871904623
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY YOUNGBLOOD MSSW
Provider Business Mailing Address
First Line : 4313 BROWNSBORO GLEN RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-4156
Country : US
Telephone Number : 502-262-2670
Fax Number :
Provider Business Practice Location Address
First Line : 2301 GOLDSMITH LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1018
Country : US
Telephone Number : 502-262-2670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2014
Last Update Date : 05/14/2014

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