Provider Demographics
NPI:1700031069
Name:BRADFORD, CYNTHIA ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:BRADFORD-PADILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMFT
Mailing Address - Street 1:30 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1637
Mailing Address - Country:US
Mailing Address - Phone:707-359-9980
Mailing Address - Fax:
Practice Address - Street 1:8 N 5TH ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1633
Practice Address - Country:US
Practice Address - Phone:707-474-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X
CALMFT112991101YM0800X
CA112991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health