Active NPI
Mallory Bradley
- Clinical Social Worker
- Manasquan, NJ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SC05719700
- Practice address
- 1211 Minnehaha TRL
Manasquan, NJ 08736-2022 - Phone
- (732) 539-2018
- NPI assigned
- Feb 8, 2017
- Last updated
- May 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC05719700 | NJ | Primary |
Addresses
Primary practice location
1211 Minnehaha TRL
Manasquan, NJ 08736-2022
Mailing address
1211 Minnehaha TRL
Manasquan, NJ 08736-2022
Phone (732) 539-2018
Other practice location 1
1118 Campus Dr
Morganville, NJ 07751-1261
Phone (732) 817-0103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Service Professionals of NJ LLC | Current | Accepting new patients | |
| Esv | Clinical | Past | Accepting new patients |
Locations
30 Montgomery St
Fl 15
Jersey City, NJ 07302
Phone (551) 247-1029
125 Chubb Ave
Ste 100
Lyndhurst, NJ 07071
Phone (201) 559-7600
125 Chubb Ave
Ste 100S
Lyndhurst, NJ 07071
Phone (201) 559-7600
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Clover Home Care
- Geriatric Medicine (Internal Medicine) Physician
- Lyndhurst, NJ
- NPI 1972044923
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588723200000",
"number": "1063950152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 MINNEHAHA TRL",
"city": "MANASQUAN",
"state": "NJ",
"postal_code": "087362022",
"telephone_number": "732-539-2018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 MINNEHAHA TRL",
"city": "MANASQUAN",
"state": "NJ",
"postal_code": "087362022",
"telephone_number": "732-539-2018"
}
],
"practiceLocations": [
{
"address_1": "1118 Campus Dr",
"address_purpose": "LOCATION",
"city": "Morganville",
"state": "NJ",
"postal_code": "077511261",
"country_code": "US",
"telephone_number": "732-817-0103",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRADLEY",
"first_name": "MALLORY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-08",
"last_updated": "2020-05-06",
"certification_date": "2020-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SC05719700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manasquan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.