Provider Demographics
NPI:1760598742
Name:BRADLEY, ROXANNE (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 ALDERSHOT WALK
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3423
Mailing Address - Country:US
Mailing Address - Phone:714-894-3139
Mailing Address - Fax:
Practice Address - Street 1:5500 E ATHERTON ST
Practice Address - Street 2:SUITE 416
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4016
Practice Address - Country:US
Practice Address - Phone:562-493-1496
Practice Address - Fax:562-493-2092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist