Doctor Name: | BRADLEY ERVIN |
NPI Number: | 1124421219 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | I.0010022-SUPV |
Business Practice Address: | 307 Boatner Rd Ste 114 Eglin Afb, FL - 325421302 |
Business Phone Number: | 8508838374 |
Business Fax Number: | |
Mailing Address: | 307 Boatner Rd Ste 114, EGLIN AFB |
State: | FL |
Postal Code: | 325421302 |
Phone Number: | 8508838374 |
Fax Number: | |
NPI Enumeration Date: | 10/02/2014 |
NPI Last Update Date: | 10/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | I.0010022-SUPV |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |