Healthcare Provider Details

I. General information

NPI: 1386722627
Provider Name (Legal Business Name): BRADLEY PARK WARNER LCSW, CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 CENTRAL AVE SPARC
ALBANY NY
12206-1504
US

IV. Provider business mailing address

226 LAKE HILL RD
BURNT HILLS NY
12027-9604
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-8888
  • Fax: 518-482-2458
Mailing address:
  • Phone: 518-796-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10232
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR058761-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: