Provider Demographics
NPI:1194566851
Name:BRADFORD, ROBIN JEQUAY
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:JEQUAY
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 N JULIA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1928
Mailing Address - Country:US
Mailing Address - Phone:414-233-0610
Mailing Address - Fax:
Practice Address - Street 1:6001 W CENTER ST STE 105
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2154
Practice Address - Country:US
Practice Address - Phone:414-873-1746
Practice Address - Fax:414-393-9773
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health