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NPI Code Detail

MEDICARE: MS. JUANITA BRADLEY LBSW

MEDICARE: MS. JUANITA BRADLEY LBSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6802062440MI

General Provider Information

NPI Number : 1013122795
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUANITA BRADLEY LBSW
Provider Business Mailing Address
First Line : 18060 BELAND ST
Second Line :
City : DETROIT
State : MI
Zip : 48234-3838
Country : US
Telephone Number : 313-372-1811
Fax Number :
Provider Business Practice Location Address
First Line : 35425 W MICHIGAN AVE
Second Line :
City : WAYNE
State : MI
Zip : 48184-9800
Country : US
Telephone Number : 734-467-7600
Fax Number : 734-467-7636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 08/08/2024

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