MEDICARE: DR. ROXANNE BRADLEY PSY.D., LMFT

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	106H00000X	Marriage & Family Therapist	MFC32313	CA

General Provider Information

NPI Number	:	1760598742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANNE BRADLEY PSY.D., LMFT

Provider Business Mailing Address
First Line	:	5572 ALDERSHOT WALK
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3423
Country	:	US
Telephone Number	:	714-894-3139
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 E ATHERTON ST
Second Line	:	SUITE 416
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4016
Country	:	US
Telephone Number	:	562-493-1496
Fax Number	:	562-493-2092

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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