Healthcare Provider Details

I. General information

NPI: 1336133651
Provider Name (Legal Business Name): BRADLEY C. GARSON MSSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 09/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N 1ST ST
BLACK RIVER FALLS WI
54615-1311
US

IV. Provider business mailing address

54 N 1ST ST PO BOX 387
BLACK RIVER FALLS WI
54615-1311
US

V. Phone/Fax

Practice location:
  • Phone: 715-797-5007
  • Fax: 715-333-5007
Mailing address:
  • Phone: 715-284-0361
  • Fax: 715-333-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2907-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: