Provider Demographics
NPI:1528155538
Name:BRADSHAW, JULIE (LICSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05648-7591
Mailing Address - Country:US
Mailing Address - Phone:802-229-4004
Mailing Address - Fax:
Practice Address - Street 1:8 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4880
Practice Address - Country:US
Practice Address - Phone:802-479-0050
Practice Address - Fax:802-479-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00009441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009857Medicaid
VT14Y001575VT01OtherANTHEM
VT59333OtherBLUE CROSS
VT2162822OtherCIGNA
VN3219Medicare ID - Type Unspecified