Provider Demographics
NPI:1467661447
Name:WATKINS, C BRADLEY (LMFT)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:BRADLEY
Last Name:WATKINS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST
Mailing Address - Street 2:G 710 TRI CITY CSC
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1513
Mailing Address - Country:US
Mailing Address - Phone:510-795-2487
Mailing Address - Fax:510-793-3972
Practice Address - Street 1:39155 LIBERTY ST
Practice Address - Street 2:G 710 TRI CITY CSC
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:510-795-2487
Practice Address - Fax:510-793-3972
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist