Provider Demographics
NPI:1386487858
Name:BARR, BRADEE LYNN (BS)
Entity type:Individual
Prefix:
First Name:BRADEE
Middle Name:LYNN
Last Name:BARR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 PORTILLO VLY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5139
Mailing Address - Country:US
Mailing Address - Phone:925-964-5352
Mailing Address - Fax:
Practice Address - Street 1:5220 PORTILLO VLY
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5139
Practice Address - Country:US
Practice Address - Phone:925-964-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician