Provider Demographics
NPI:1093857666
Name:BRADSHAW, KAREN DIANE
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DIANE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:DIANE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 DANIELS AVE # A
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3036
Mailing Address - Country:US
Mailing Address - Phone:707-205-7778
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR
Practice Address - Street 2:BLDG. 2
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-554-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)