Provider Demographics
NPI:1104492420
Name:BRADSHAW, JOHN ANDREW (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10528
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-0528
Mailing Address - Country:US
Mailing Address - Phone:510-599-9845
Mailing Address - Fax:
Practice Address - Street 1:1231 MARKET ST STE 810
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1405
Practice Address - Country:US
Practice Address - Phone:510-599-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist