Provider Demographics
NPI:1134428238
Name:BRADLEY, DEE-ANNA R (PSYD)
Entity type:Individual
Prefix:
First Name:DEE-ANNA
Middle Name:R
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DEE-ANNA
Other - Middle Name:
Other - Last Name:DREIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, LPCC
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95634-0983
Mailing Address - Country:US
Mailing Address - Phone:530-391-9976
Mailing Address - Fax:
Practice Address - Street 1:319 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5605
Practice Address - Country:US
Practice Address - Phone:530-391-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist