Healthcare Provider Details

I. General information

NPI: 1710094206
Provider Name (Legal Business Name): BRADLEY JOSEPH SCHAFFER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST 116CP/FTD
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST 116CP/FTD
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 859-572-6222
Mailing address:
  • Phone: 513-861-3100
  • Fax: 859-572-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082666
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: