Healthcare Provider Details

I. General information

NPI: 1710868682
Provider Name (Legal Business Name): ELEANOR GRACE BRADLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 POST RD E
WESTPORT CT
06880-3616
US

IV. Provider business mailing address

250 POST RD E
WESTPORT CT
06880-3616
US

V. Phone/Fax

Practice location:
  • Phone: 203-227-4555
  • Fax:
Mailing address:
  • Phone: 860-205-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17217
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4189
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: