Provider Demographics
NPI:1073724209
Name:BRADSHAW MACLYMAN, SUSAN ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BRADSHAW MACLYMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 TORRANCE BLVD
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2635
Mailing Address - Country:US
Mailing Address - Phone:310-803-7590
Mailing Address - Fax:310-783-0223
Practice Address - Street 1:2171 TORRANCE BLVD
Practice Address - Street 2:SUITE # 5
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2635
Practice Address - Country:US
Practice Address - Phone:310-803-7590
Practice Address - Fax:310-783-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist