Provider Demographics
NPI:1215083795
Name:BRADLEY, JULIA MOON (PSYD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MOON
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2235
Mailing Address - Country:US
Mailing Address - Phone:510-835-2777
Mailing Address - Fax:510-835-0164
Practice Address - Street 1:255 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2235
Practice Address - Country:US
Practice Address - Phone:510-835-2777
Practice Address - Fax:510-835-0164
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARSP2005187390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program