Healthcare Provider Details

I. General information

NPI: 1528155538
Provider Name (Legal Business Name): JULIE BRADSHAW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MAIN ST STE B
BARRE VT
05641-4880
US

IV. Provider business mailing address

1189 WHEELER RD
CALAIS VT
05648-7591
US

V. Phone/Fax

Practice location:
  • Phone: 802-479-0050
  • Fax: 802-479-0056
Mailing address:
  • Phone: 802-229-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000944
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: