=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952367153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA J HAYMAN BRADSHAW LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 11/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 BUFFALO RD BUILDING 100 SUITE B
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14624-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-338-7972
-----------------------------------------------------
Fax | 585-338-2581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 EASTBOURNE RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14617-5648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-338-7972
-----------------------------------------------------
Fax | 585-338-2581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 036739
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------