Healthcare Provider Details

I. General information

NPI: 1891400560
Provider Name (Legal Business Name): SARAH ELIZABETH BRADLEY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 10TH ST
IMPERIAL BEACH CA
91932-2216
US

IV. Provider business mailing address

1700 SAN PABLO RD S APT 904
JACKSONVILLE FL
32224-2049
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: