Provider Demographics
NPI:1598318693
Name:BRADSHAW, BRIANNA L (LCSW, MSSW)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:L
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 E 10TH ST # 166
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7285
Mailing Address - Country:US
Mailing Address - Phone:812-670-5202
Mailing Address - Fax:
Practice Address - Street 1:3310 E 10TH ST # 166
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-7285
Practice Address - Country:US
Practice Address - Phone:812-670-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009311A104100000X
IN34009480A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1578685160Medicaid