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Individual
MS. NANCY BRADSTREET
Active
Individual
MS. NANCY BRADSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0000152
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11241384
CASH ID#
—
01
—
134535
VALUE OPTIONS
—
01
—
PIN #0004619353
AETNA
—
01
—
PIN #199570
MANAGED HEALTH NETWORK
—
01
—
PROVIDER #6259615
UNITED BEHAVIORAL HEALTH
—
Enumeration date
02/05/2007
Last updated
07/08/2007
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