BRADLEY ALLAN LAKE LMSW
NPI 1083261705
Social Worker in Detroit, MI

Q: What is Bradley Lake's NPI number?

The NPI number for Bradley Lake is 1083261705. It was assigned to this individual provider in the NPPES registry on August 19, 2019.

Q: What is Bradley Lake's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: When was this NPI record last updated?

The NPPES record for Bradley Lake was last updated on July 12, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since August 19, 2019PECOS EnrolledAccepts Medicare Assignment

2925 RUSSELL ST, DETROIT, MI 48207(313) 396-5300(313) 396-5353 Get Directions Write a Review

NPPES record last updated: July 12, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 12, 2022, Aug 19, 2019 (2 updates tracked since 2019).

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About Bradley Allan Lake Lmsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRADLEY ALLAN LAKE LMSW (NPI 1083261705) is an individual social worker in Detroit, Michigan, licensed in Michigan (6801113780) and active in the NPI registry since August 2019. He is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1083261705

Entity TypeIndividualMale

Primary Taxonomy104100000X

Provider Legal NameBRADLEY ALLAN LAKECredential: LMSW

Location Address2925 RUSSELL STDetroit, MI 48207-4825

Mailing Address4131 Clippert StDearborn Heights, MI 48125-2732 · (313) 680-0019

Phone(313) 396-5300

Fax(313) 396-5353

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateAugust 19, 2019

Last NPPES UpdateJuly 12, 20222 updates tracked since enumeration

NPPES CertifiedJuly 12, 2022

✔ NPI 1083261705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

License✔ Licensed in MI · 6801113780

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X · License 6801113780 (MI)

2925 RUSSELL ST, Detroit, MI 48207

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Bradley Allan Lake Lmsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648663419

PECOS Enrollment IDI20220201000183

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LILLIAN PATRICIA HATHORNE

Case Manager/Care Coordinator