Matthew Bradley, LISW

Key facts

NPI

1831864974

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

I.1700336 (OH)

Practice address

9777 Mulligans Bluff Rd
Defiance, OH 43512-9751

Phone

(419) 202-5623

NPI assigned

Aug 11, 2021

Sex

Male

Sole proprietor

Yes

Organizations & group practices 1

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.

• Internal Harmony LLC Clinical Social Worker · Defiance, OH · NPI 1528899044
  NPD Authorized official CLINICAL

Medicare participation

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 11, 2021.

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1831864974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9777 MULLIGANS BLUFF RD",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435129751",
            "telephone_number": "419-202-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9777 MULLIGANS BLUFF RD",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435129751",
            "telephone_number": "419-202-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MATTHEW",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-11",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1700336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Defiance",
            "affiliation": "N",
            "endpointDescription": "Home Office",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "9777 Mulligans Bluff Rd",
            "city": "Defiance",
            "state": "OH",
            "country_code": "US",
            "postal_code": "435129751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Defiance, OH

• Randi N. Bookenberger, CDCA & QMHS
• Alyssa Marie Borton, RN
• Lauren Bosch, PHARMD, RPH
• Eric W Bowers, PT
• Darci Bowser
• Renee Brents, COTA/L
• Megan Elizabeth Brinkman, PHARMD
• Katherine Brooke
• Brookview Operating Company LLC
• Paul E Brose, M.D.

All providers in Defiance, OH · Clinical Social Worker in Ohio