Bradley J Redeker, LMSW, APBCC, CCTP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801095932 Issued in MI

Practice address

3280 E Beltline CT NE Ste 100
Grand Rapids, MI 49525-9494

Phone

(616) 610-9994

NPI assigned

Sep 16, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Counseling Center of West Michigan, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1437610730
  Medicare reassignment NPD
• Family Outreach Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Rapids, MI
  • NPI 1619980927
  NPD (past)
• Virtuwell Therapy, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1871356212
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582329600000",
    "number": "1104252626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 LILLY CT SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099204",
            "telephone_number": "616-610-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 E BELTLINE CT NE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259494",
            "telephone_number": "616-610-9994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 Colrain St SW Ste 2",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495481013",
            "country_code": "US",
            "telephone_number": "616-988-1479",
            "fax_number": "616-988-1493",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "221 Trowbridge St NE Unit 208",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "49503",
            "country_code": "US",
            "telephone_number": "616-499-7711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REDEKER",
        "first_name": "BRADLEY",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "LMSW, APBCC, CCTP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-16",
        "last_updated": "2020-02-22",
        "certification_date": "2020-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL05879000",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801095932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bredeker@northeastgrcounseling.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3280 E Beltline Ct NE Ste 100",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495259494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brandi Redd
• Colten Redder, PHARMD
• Emily Kniowski Redder, RDN
• Haritha Ganesh Reddy, M.D.
• Miranda Reddy, NP
• Austin James Redick, PA-C
• Kayla Redko, ATC
• Alexander William Redman, MD
• Leslie Yvonne Redmon, REGISTERED NURSE
• Redmond Counseling LLC

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.

Verify at the official NPI Registry.