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General NPI Number Information
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NPI Number | 1487273645
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Entity Type | Individual
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Provider Name | VICTORIA JEANNE BRADDOCK LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 805 S BEADLE ST
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City | PAPILLION
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State | NE
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Zip | 68046-2755
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Country | US
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Telephone | 530-417-7977
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Fax |
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Provider Business Mailing Address
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Address Line | 805 S BEADLE ST
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City | PAPILLION
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State | NE
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Zip | 68046-2755
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Country | US
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Telephone | 530-417-7977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW85165
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 103728
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License Number State | CA
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