Provider Demographics
NPI:1558928622
Name:BRADSHAW, BARBARA ANN (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WARREN RD STE 10A
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2452
Mailing Address - Country:US
Mailing Address - Phone:443-860-1252
Mailing Address - Fax:
Practice Address - Street 1:111 WARREN RD STE 10A
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2452
Practice Address - Country:US
Practice Address - Phone:443-860-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0011264101YP2500X
PA014586101YP2500X
MDLC8746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9585OtherBCBS