Dianne M Bradley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

256419 Issued in KY

Practice address

100 Par LN Ste 102
Elizabethtown, KY 42701-9059

Phone

(423) 817-8818

NPI assigned

Oct 17, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1750666152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 LAVENIA LN",
            "city": "MAGNOLIA",
            "state": "KY",
            "postal_code": "427577823",
            "telephone_number": "423-817-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PAR LN STE 102",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427019059",
            "telephone_number": "423-817-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "DIANNE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-17",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904008413",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "5837",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50081103",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "256419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100822370",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren M Bowlin, NP
• Elisha Reed Bowman, CADC
• Selena Gail Boyd, PA-C
• Kaleb Boydston, MS, ATC
• Jennifer Braden, M.ED.
• Moriah J Bradley, TCADC
• Stephanie Lynn Brady
• Brandon L Houk MD PSC
• Brandy Givan
• Carrie Ann Brangers, M.S., OTR/L

• Clinical Social Worker in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.