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General NPI Number Information
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NPI Number | 1215340773
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Entity Type | Individual
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Provider Name | BRADLEY CARROLL MSW, LGSW
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Gender | Male
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 8591 HOLLY MEADOWS RD
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City | PARSONS
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State | WV
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Zip | 26287-8604
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Country | US
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Telephone | 304-478-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 8591 HOLLY MEADOWS RD
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City | PARSONS
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State | WV
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Zip | 26287-8604
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Country | US
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Telephone | 304-478-3339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2012-2932
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04990
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | BP00947033
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License Number State | WV
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