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General NPI Number Information
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NPI Number | 1841767795
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Entity Type | Organization
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Legal Business Name | ROSE A BRADSHAW, LCSW, PA
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 40 FOREST FALLS DR STE 3
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City | YARMOUTH
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State | ME
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Zip | 04096-6905
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Country | US
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Telephone | 207-671-0305
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Fax | 207-669-4837
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Provider Business Mailing Address
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Address Line | 137 MIDDLE RD
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City | CUMBERLAND
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State | ME
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Zip | 04021-3710
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Country | US
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Telephone | 207-671-0305
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Fax | 207-669-4837
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSE A BRADSHAW
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Credential | LCSW
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Telephone | 207-671-0305
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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 |
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License Number State |
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