Healthcare Provider Details

I. General information

NPI: 1982698098
Provider Name (Legal Business Name): WILLIAM LOWELL BRADLEY M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E BROADWAY RD #25
TEMPE AZ
85282-1879
US

IV. Provider business mailing address

2101 E BROADWAY RD #25
TEMPE AZ
85282-1879
US

V. Phone/Fax

Practice location:
  • Phone: 480-921-3711
  • Fax: 480-921-0307
Mailing address:
  • Phone: 480-921-3711
  • Fax: 480-921-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 0107I
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-0085
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: