MEDICARE: CAROLINE BRADBURY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LW60296757	WA

General Provider Information

NPI Number	:	1265886600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE BRADBURY

Provider Business Mailing Address
First Line	:	5607 41ST AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5607 41ST AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1506
Country	:	US
Telephone Number	:	206-660-3098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/22/2016

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Directions to “ CAROLINE BRADBURY ” Practice Location

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