Active NPI
Charlotte Wiethoff-Bradley, MFT
- Marriage & Family Therapist
- Redondo Beach, CA
National Provider Identifier
1518104389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 46587
- Practice address
- 1200 Aviation Blvd Ste 102
Redondo Beach, CA 90278-4064 - Phone
- (310) 372-4245
- Fax
- (310) 379-6407
- NPI assigned
- Jan 14, 2009
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 46587 | CA | Primary |
Addresses
Primary practice location
1200 Aviation Blvd Ste 102
Redondo Beach, CA 90278-4064
Mailing address
703 Pier Ave Ste B196
Hermosa Beach, CA 90254-3949
Phone (310) 612-6299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 29, 2024 through Jan 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424044800000",
"number": "1518104389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 PIER AVE STE B196",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902543949",
"telephone_number": "310-612-6299",
"fax_number": "310-379-6407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 AVIATION BLVD STE 102",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902784064",
"telephone_number": "310-372-4245",
"fax_number": "310-379-6407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIETHOFF-BRADLEY",
"first_name": "CHARLOTTE",
"name_prefix": "Ms.",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-14",
"last_updated": "2015-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "46587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
- Robert Charles White Jr., DDS
- Jennifer Mae Whitehall, BCBA
- Threasa Whitehead, FNP-C
- Whole Life Medical Group Inc.
- William James Wickwire, MD
- Mary Wiggins, LMFT, LPCC
- Dennis E Wild, DC
- Jamie Wilhelm
- Yasmine Wilhite
- William J Wickwire M D Inc a Professional Corporation (Beach Cities Dematology Med Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.