MEDICARE: MS. PATRICIA J HAYMAN BRADSHAW LCSW

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	101YM0800X	Mental Health Counselor	036739	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO10036739	OTHER	NY	BLUE CROSS/BLUE CHOICE
2	PO10036739	OTHER	NY	BLUE CROSS/BLUE SHIELD/CH
3	PO10036739	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1952367153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA J HAYMAN BRADSHAW LCSW

Provider Business Mailing Address
First Line	:	52 EASTBOURNE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5648
Country	:	US
Telephone Number	:	585-338-7972
Fax Number	:	585-338-2581

Provider Business Practice Location Address
First Line	:	2300 BUFFALO RD
Second Line	:	BUILDING 100 SUITE B
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1360
Country	:	US
Telephone Number	:	585-338-7972
Fax Number	:	585-338-2581

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	11/19/2007

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