Provider Demographics
NPI:1619519857
Name:BACHMAN, BRADLEY POLSON
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:POLSON
Last Name:BACHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 VENTURA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1935
Mailing Address - Country:US
Mailing Address - Phone:301-503-5551
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 133
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2480
Practice Address - Country:US
Practice Address - Phone:510-553-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health