Provider Demographics
NPI:1356797146
Name:BRADFORD, LEAH JO (LCSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JO
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:JO
Other - Last Name:PYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5638 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-5042
Mailing Address - Country:US
Mailing Address - Phone:888-714-1927
Mailing Address - Fax:317-247-8935
Practice Address - Street 1:5610 CRAWFORDSVILLE RD STE 2201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3784
Practice Address - Country:US
Practice Address - Phone:317-244-2792
Practice Address - Fax:317-243-2328
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34008824A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
INHX2520Medicaid