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NPI Code Detail

MEDICARE: BRADLEY CARROLL MSW, LGSW

MEDICARE: BRADLEY CARROLL MSW, LGSW
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
1171M00000XCase Manager/Care Coordinator
2225700000XMassage Therapist2012-2932WV
3225700000XMassage TherapistM04990MD
41041S0200XSchool Social WorkerBP00947033WV

General Provider Information

NPI Number : 1215340773
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY CARROLL MSW, LGSW
Provider Business Mailing Address
First Line : 8591 HOLLY MEADOWS RD
Second Line :
City : PARSONS
State : WV
Zip : 26287-8604
Country : US
Telephone Number : 304-478-3339
Fax Number :
Provider Business Practice Location Address
First Line : 8591 HOLLY MEADOWS RD
Second Line :
City : PARSONS
State : WV
Zip : 26287-8604
Country : US
Telephone Number : 304-478-3339
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2014
Last Update Date : 04/01/2025

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