Active NPI
Connie G Bradley, L.C.S.W.
- Clinical Social Worker
- Wartburg, TN
National Provider Identifier
1669859385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7517
- Practice address
- 224 Old Mill Rd
Wartburg, TN 37887-4163 - Phone
- (423) 346-6221
- Fax
- (423) 346-5565
- NPI assigned
- May 1, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 10355 | TN | |
| Clinical Social Worker | 1041C0700X | 7517 | TN | Primary |
Addresses
Primary practice location
224 Old Mill Rd
Wartburg, TN 37887-4163
Mailing address
PO Box 408
Wartburg, TN 37887-0408
Phone (423) 346-6221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10355 | TN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1669859385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 408",
"city": "WARTBURG",
"state": "TN",
"postal_code": "378870408",
"telephone_number": "423-346-6221",
"fax_number": "423-346-5565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 OLD MILL RD",
"city": "WARTBURG",
"state": "TN",
"postal_code": "378874163",
"telephone_number": "423-346-6221",
"fax_number": "423-346-5565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "CONNIE",
"middle_name": "G",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-01",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "10355",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "7517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wartburg, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.