Provider Demographics
NPI:1447261334
Name:WOOD, BRAD WINTHROP (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:WINTHROP
Last Name:WOOD
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43646 REMBRANDT ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-5745
Mailing Address - Country:US
Mailing Address - Phone:661-917-1304
Mailing Address - Fax:661-418-6178
Practice Address - Street 1:43646 REMBRANDT ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-5745
Practice Address - Country:US
Practice Address - Phone:661-917-1304
Practice Address - Fax:661-418-6178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS200251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical