Medea Elizabeth Bradberry, LCSW, LSCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2019035423 Issued in MO

Practice address

1213 R D Mize Rd Apt a
Grain Valley, MO 64029-9462

Phone

(573) 999-2733

NPI assigned

Sep 24, 2020

Last updated

Sep 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Medea Elizabeth Caver Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1245847169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 R D MIZE RD APT A",
            "city": "GRAIN VALLEY",
            "state": "MO",
            "postal_code": "640299462",
            "telephone_number": "573-999-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 R D MIZE RD APT A",
            "city": "GRAIN VALLEY",
            "state": "MO",
            "postal_code": "640299462",
            "telephone_number": "573-999-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADBERRY",
        "first_name": "MEDEA",
        "middle_name": "ELIZABETH",
        "credential": "LCSW, LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "5214",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2019035423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kiesslingandassociates.org",
            "affiliation": "N",
            "endpointDescription": "Company Website",
            "address_1": "1213 R D Mize Rd Apt A",
            "city": "Grain Valley",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640299462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MEDEA",
            "last_name": "CAVER",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Grain Valley, MO
• Providers in Grain Valley, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.