Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | ISW6716 | FL |
Y | 1041C0700X | Clinical Social Worker | SW11449 | FL |
NPI | 1003253402 |
---|---|
Provider Name | Karen E Bradt |
First Address | Daytona Beach, FL 32114-5079 |
Second Address | Daytona Beach, FL 32114-5079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2013 |
Last Update Date | 12/05/2015 |