Provider Demographics
NPI:1659631992
Name:PATRICIA HAYMAN BRADSHAW LCSW PC
Entity Type:Organization
Organization Name:PATRICIA HAYMAN BRADSHAW LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:HAYMAN
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-349-2829
Mailing Address - Street 1:85 S UNION ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1255
Mailing Address - Country:US
Mailing Address - Phone:585-349-2829
Mailing Address - Fax:585-349-2767
Practice Address - Street 1:85 S UNION ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1255
Practice Address - Country:US
Practice Address - Phone:585-349-2829
Practice Address - Fax:585-349-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036739-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty