Provider Demographics
NPI:1689861247
Name:BRADSHAW, MARY HILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:HILL
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 SADDLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2383
Mailing Address - Country:US
Mailing Address - Phone:804-539-1177
Mailing Address - Fax:
Practice Address - Street 1:5715 SADDLE HILL DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2383
Practice Address - Country:US
Practice Address - Phone:804-539-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003607103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical