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General NPI Number Information
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NPI Number | 1932423241
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Entity Type | Individual
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Provider Name | DEVVON BRADLEY M.S.W
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Gender | Male
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVENUE NORTHWEST
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-3412
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Fax |
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Provider Business Mailing Address
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Address Line | 7824 HARRIS LOOP
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City | FORT MEADE
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State | MD
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Zip | 20755-1121
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Country | US
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Telephone | 301-326-7524
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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 | C003316
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License Number State | NC
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