Jennifer K Bradley, LCSW – Social Worker

Key facts

NPI: 1942518261
Entity type: Individual (NPI type 1)
Primary specialty: Social Worker 104100000X
License: 2013035767 (MO)
Practice address: 10004 Kennerly Rd Ste 362B
Saint Louis, MO 63128-2178
Phone: (314) 525-1000
NPI assigned: Sep 21, 2010
Sex: Female
Sole proprietor: No

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.

Community and Long-Term Care Psychiatry LLC Psychiatry Physician · Saint Louis, MO · NPI 1699121475

Medicare reassignment Care Compare group MO

Medicare Care Compare profile

Specialty: Clinical Social Worker
Education: Other, 2010
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Community and Long-Term Care Psychiatry LLC (14 clinicians)

Practice addresses (Care Compare)

10004 Kennerly Rd
Suite 362B
Saint Louis, MO 63128-2178
Phone (314) 525-5050

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MO
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20180618001814	MO	Practitioner - Clinical Social Worker	6002051968	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Interoperability endpoints

Direct secure messaging: jennifer.bradley.1@20454.direct.athenahealth.com

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	149015702	IL
Social Worker	104100000X	2013035767	MO	Yes

Addresses

Primary practice location

10004 Kennerly Rd Ste 362B
Saint Louis, MO 63128-2178

Mailing address

621 Bernard Dr
Belleville, IL 62223-3212
Phone (636) 638-7802

Other providers in Saint Louis, MO

Cole Russell Bradley, B.A.
Crystal Bradley
Darryl Lionel Bradley, D.C.
Harry A. Bradley, PSYCHOLOGIST
Jeffrey D Bradley, MD
Kristi Zerbes Bradley
Leonard Eugene Bradley, MSE, CCDP-D, ICCDP-D
Lisa Charisee Bradley, REGISTERED NURSE
Margaret Mary Bradley, CRNA
Matthew Walter Bradley, MD

All providers in Saint Louis, MO · Social Worker in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.