MEDICARE: BLANCA F. 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	LCSW93353	CA

General Provider Information

NPI Number	:	1891230439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA F. BRADLEY

Provider Business Mailing Address
First Line	:	700 N BRAND BLVD FL 10
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1202
Country	:	US
Telephone Number	:	818-524-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N BRAND BLVD FL 10
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1202
Country	:	US
Telephone Number	:	818-524-8899
Fax Number	:

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

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	08/23/2021

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