Provider Demographics
NPI:1568823441
Name:BRADSHAW, ROBERTA HEATH (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:HEATH
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MILLER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2844
Mailing Address - Country:US
Mailing Address - Phone:415-383-8430
Mailing Address - Fax:415-383-7855
Practice Address - Street 1:311 MILLER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2844
Practice Address - Country:US
Practice Address - Phone:415-383-8430
Practice Address - Fax:415-383-7855
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT25558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist