Bradley Royce Pendergraft, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2227 Issued in OR

Practice address

6105 SW Macadam Ave
Suite 100
Portland, OR 97239-3640

Phone

(503) 327-8713

Fax

(503) 200-1082

NPI assigned

Feb 21, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Lifetime Optimization, Inc.

  • Clinical Social Worker
  • Portland, OR
  • NPI 1700127941
  NPD (past) Authorized official

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361404800000",
    "number": "1386984854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6105 SW MACADAM AVE",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393640",
            "telephone_number": "503-327-8713",
            "fax_number": "503-200-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6105 SW MACADAM AVE",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393640",
            "telephone_number": "503-327-8713",
            "fax_number": "503-200-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAFT",
        "first_name": "BRADLEY",
        "middle_name": "ROYCE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-21",
        "last_updated": "2013-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "2227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Rojo Pena, RN
• Felicitas Amelia Penaloza
• Alexandra Penaluna
• Jennifer Morgan Penberthy, MA
• Maia Lucy Penchansky, PCA, RD, LD
• Paul Pendergraft, AU.D.
• Melissa Pendergrass, M.D.
• Tyson Pendery
• Julie Anne Pendleton, N.D.
• Fei Peng

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; 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.