Healthcare Provider Details

I. General information

NPI: 1548574551
Provider Name (Legal Business Name): BRANDY BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWER WAY SUITE 110
BAKERSFIELD CA
93309-1597
US

IV. Provider business mailing address

701 SCOFIELD AVE
WASCO CA
93280-7515
US

V. Phone/Fax

Practice location:
  • Phone: 661-859-2135
  • Fax:
Mailing address:
  • Phone: 661-758-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: