MEDICARE: MRS. ALEXANDRA BRADFORD LCSW-C

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	104100000X	Social Worker	22832	MD
2	1041C0700X	Clinical Social Worker	22832	MD

General Provider Information

NPI Number	:	1982169975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA BRADFORD LCSW-C

Provider Business Mailing Address
First Line	:	2518 E FAIRMOUNT AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-1133
Country	:	US
Telephone Number	:	410-725-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 PENNINGTON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21226-1405
Country	:	US
Telephone Number	:	410-355-3285
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	01/20/2022

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