SHANNON DEIRDRE BRADLEY (LCSW) – Clinical Social Worker, NPI 1053720557

SHANNON DEIRDRE BRADLEY (LCSW) is a healthcare provider. based in Fort myers, Florida. specializing in Clinical Social Worker. They hold the professional credentials LCSW. They hold a License No. SW 13312 (FL). The NPI Number for SHANNON DEIRDRE BRADLEY (LCSW) is 1053720557

Main info

Female
Sole Proprietor
14 Years Of Experience
Accepts Medicare Assignment
Name
SHANNON DEIRDRE BRADLEY (LCSW)
NPI
1053720557
Phone
(239) 939-9090
Address
12590 WHITEHALL DR
Enumeration Date
8 August 2014
Last Update Date
22 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2399399090
Graduation Year
2012 (14 years ago)
PAC ID
8022315514
Group Practice PAC ID
5395647754
Professional Enrollment ID
I20160329000423
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience46
Completeness75
Years active:11State licenses:1Digital endpointsOther names

Provider Addresses for SHANNON DEIRDRE BRADLEY (LCSW)

  • 12590 WHITEHALL DR

    SUITE 1

    FORT MYERS, FL 339074680

    Phone: (239) 939-9090

    Type: Mailing

  • 5502 MARVIN SHIELDS BLVD

    GULFPORT, MS 39501

    Phone: (282) 822-5710

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

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No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33907)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5395647754View full group profile
NameSpecialtyState
DR. JEANETTE A BEVILACQUA (ARNP)
-FL
KAREN S WOODS (PMHNP)
-FL
SUSAN COBB (L.C.S.W)
-FL

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Frequently asked questions

Is there an official ID for SHANNON DEIRDRE BRADLEY (LCSW) in U.S. healthcare records?
The official identifier for SHANNON DEIRDRE BRADLEY (LCSW) is NPI 1053720557.
Is there an active status for SHANNON DEIRDRE BRADLEY (LCSW)?
For scheduling context, SHANNON DEIRDRE BRADLEY (LCSW) is shown as active in the registry.
What area of care is associated with SHANNON DEIRDRE BRADLEY (LCSW)?
SHANNON DEIRDRE BRADLEY (LCSW)'s record emphasizes Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What locale is associated with SHANNON DEIRDRE BRADLEY (LCSW)?
Directory geography for SHANNON DEIRDRE BRADLEY (LCSW) centers on Fort Myers, Florida.
What does 4 location(s) imply?
4 practice locations appear in the available data.

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