MEDICARE: SARAH 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	P008901	NC

General Provider Information

NPI Number	:	1740695501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BRADLEY

Provider Business Mailing Address
First Line	:	2130 FOREST HILLS RD W
Second Line	:	SUITE A
City	:	WILSON
State	:	NC
Zip	:	27893-3680
Country	:	US
Telephone Number	:	252-265-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 FOREST HILLS RD W
Second Line	:	SUITE A
City	:	WILSON
State	:	NC
Zip	:	27893-3680
Country	:	US
Telephone Number	:	252-265-9200
Fax Number	:

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

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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Directions to “ SARAH BRADLEY ” Practice Location

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