MEDICARE: EDALMARYS SANTOS BRADFORD LMHC

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
1	101YM0800X	Mental Health Counselor	MH15636	FL

General Provider Information

NPI Number	:	1407701576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDALMARYS SANTOS BRADFORD LMHC

Provider Business Mailing Address
First Line	:	21525 NORTHWOOD DR
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-4102
Country	:	US
Telephone Number	:	615-294-2983
Fax Number	:

Provider Business Practice Location Address
First Line	:	21525 NORTHWOOD DR
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-4102
Country	:	US
Telephone Number	:	615-294-2983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/05/2026

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