Provider Demographics
NPI:1780865600
Name:PATRICIA HAYMAN BRADSHAW LCSW
Entity Type:Organization
Organization Name:PATRICIA HAYMAN BRADSHAW LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HAYMAN BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LCSW
Authorized Official - Phone:585-349-2829
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:N. CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514
Mailing Address - Country:US
Mailing Address - Phone:585-594-4574
Mailing Address - Fax:585-594-4445
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:2007-11-19
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036739-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health