Provider Demographics
NPI:1144552829
Name:BRADLEY, WALTER THOMAS JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:THOMAS
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9085 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4136
Mailing Address - Country:US
Mailing Address - Phone:954-317-2753
Mailing Address - Fax:
Practice Address - Street 1:1492 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2209
Practice Address - Country:US
Practice Address - Phone:305-541-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW96251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical