Provider Demographics
NPI:1437239910
Name:BRADSHAW, ROSE ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANNE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:BRADSHAW
Other - Last Name:NORTHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:137 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3710
Mailing Address - Country:US
Mailing Address - Phone:207-671-0305
Mailing Address - Fax:207-829-8538
Practice Address - Street 1:25 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4869
Practice Address - Country:US
Practice Address - Phone:207-671-0305
Practice Address - Fax:207-829-8538
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC117441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1437239910Medicaid