Provider Demographics
NPI:1043105794
Name:BRADSHAW, TOBI (MS, EDS)
Entity type:Individual
Prefix:
First Name:TOBI
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1322
Mailing Address - Country:US
Mailing Address - Phone:804-614-6918
Mailing Address - Fax:
Practice Address - Street 1:5608 BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:ROCK HALL
Practice Address - State:MD
Practice Address - Zip Code:21661-1604
Practice Address - Country:US
Practice Address - Phone:410-778-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
MD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool