Provider Demographics
NPI:1467638403
Name:BRADSTREET, PATRICIA ANN (CAS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BRADSTREET
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2011
Mailing Address - Country:US
Mailing Address - Phone:207-992-7070
Mailing Address - Fax:
Practice Address - Street 1:34 OLD STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:ME
Practice Address - Zip Code:04468-4332
Practice Address - Country:US
Practice Address - Phone:207-827-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health