MEDICARE: STACY BRADLEY

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	1041C0700X	Clinical Social Worker	P022353	NC

General Provider Information

NPI Number	:	1679723852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY BRADLEY

Provider Business Mailing Address
First Line	:	380 RALEIGH ST
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9047
Country	:	US
Telephone Number	:	919-521-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 RALEIGH ST
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9047
Country	:	US
Telephone Number	:	919-521-5372
Fax Number	:

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

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	12/30/2025

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Directions to “ STACY BRADLEY ” Practice Location

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