Provider Demographics
NPI:1770221400
Name:COBURN, BRADFORD (CPSS)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:COBURN
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 TULANE AVE # 3
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7185
Mailing Address - Country:US
Mailing Address - Phone:504-270-4738
Mailing Address - Fax:
Practice Address - Street 1:3303 TULANE AVE # 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7185
Practice Address - Country:US
Practice Address - Phone:504-270-4738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician