Paul L Bradford, ACSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

217453 Issued in CA

Practice address

275 Beck Ave
Fairfield, CA 94533-6804

Phone

(707) 784-8501

Fax

(707) 428-6542

NPI assigned

Nov 14, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 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": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1629613575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 CHRISTIANSEN CIR",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "957765588",
            "telephone_number": "707-319-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 BECK AVE",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336804",
            "telephone_number": "707-784-8501",
            "fax_number": "707-428-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "PAUL",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "ACSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-14",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "217453",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "217453",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSOCIATE CLINICAL SOCIAL WORKER REG #",
            "identifier": "ASW102007",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Ann Boykin
• Lauren Boynton
• Jacqueline Bracy
• Braden Partners LP
• Jeanah Braden, M.D.
• Rachel Bradford
• Bradley J Sandler MD Inc
• Bill Mack Bradley Jr.
• Keana Rose Bradley, MHRS
• John Albert Bradshaw Jr.

• Mental Health Counselor in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.