Healthcare Provider Details

I. General information

NPI: 1912765223
Provider Name (Legal Business Name): FALON BRADLEY LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MACK AVE
DETROIT MI
48207-2302
US

IV. Provider business mailing address

27369 PIERCE ST
SOUTHFIELD MI
48076-3559
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax: 313-924-8145
Mailing address:
  • Phone: 586-459-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852093958
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120450
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: