=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356550925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY JAY WERLEY L.C.S.W.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 733 WASHINGTON RD SUITE #301
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15228-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-561-4494
-----------------------------------------------------
Fax | 412-561-0887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 ASHLAND AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15228-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-561-1477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW013441
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------