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General NPI Number Information
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NPI Number | 1538423702
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Entity Type | Individual
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Provider Name | BRADLEY SPENCER LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 928 BROADWAY STE 304
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City | NEW YORK
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State | NY
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Zip | 10010-8154
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Country | US
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Telephone | 212-602-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 928 BROADWAY STE 304
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City | NEW YORK
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State | NY
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Zip | 10010-8154
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082639
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License Number State | NY
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