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Robert Ray Bradley

Social Worker

Behavioral Health & Social Service Providers

751 Thimble Shoals Blvd, Suite K, Newport News, VA 23606-3563

PECOS Enrollment

Based on the most recent information from CMS, provider Robert Ray Bradley does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1386714079
Provider Type
Individual
Full Name
Bradley, Robert Ray
Title
Mr.
Credential
LCSW, LSATP, CSAC,

Gender
Male
Sole Proprietor
No
Enumeration Date
11/9/2006
Last Updated
7/3/2013

Contact Information

Practice Location

751 Thimble Shoals Blvd, Suite K, Newport News, VA 23606-3563

(757) 812-1358

Unlisted Fax

Mailing Location

PO Box 247, Achilles, VA 23001-0247

(757) 812-1358

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 0904003692 Virginia

Provider Identifiers

ID	Description	Issuer
ID 010103550	Description Medicaid	Issuer Unlisted Virginia

Robert Ray Bradley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Williams, Tamara Lynn

Mensah, Chad

Allen, Alison Ohsol

O'Garro, Karimah Patrice

Oyeneyin, Shantora

Rissling Matthews, Erin

Hambright, Jennifer Lynn

Johnson, Tonya

Leaphart, Dana Olivia

Cheryl Kabana-Ross, Pc