Provider Demographics
NPI:1851842835
Name:BRADBURN, CARLA S
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:BRADBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:GEROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9581 PEARL CIR
Mailing Address - Street 2:UNIT #105
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4220
Mailing Address - Country:US
Mailing Address - Phone:408-203-8797
Mailing Address - Fax:
Practice Address - Street 1:9581 PEARL CIRCLE
Practice Address - Street 2:#105
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:408-203-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health