Provider Demographics
NPI:1255841771
Name:BRADSHAW, ANNA KATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHERINE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1728
Mailing Address - Country:US
Mailing Address - Phone:973-224-0811
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY PL FL 4
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7500
Practice Address - Country:US
Practice Address - Phone:973-224-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL060904001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical