Individual
BRADI PATRICE SULLIVAN
Active
Individual
BRADI PATRICE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
WA
1041C0700X
Clinical Social Worker
0904016390
VA
1041C0700X
Clinical Social Worker
127400
IA
1041C0700X
Clinical Social Worker
Primary
LW61330062
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0140722
—
IA
05
—
2182977
—
WA
05
—
30017765220001
—
VA
Enumeration date
07/12/2021
Last updated
01/15/2025
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