Provider Demographics
NPI:1558874594
Name:BRADSHAW, MELANY (LMHC)
Entity Type:Individual
Prefix:
First Name:MELANY
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 PARK AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-3429
Mailing Address - Country:US
Mailing Address - Phone:518-879-6804
Mailing Address - Fax:
Practice Address - Street 1:650 WARREN ST STE 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2900
Practice Address - Country:US
Practice Address - Phone:518-292-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health