Provider Demographics
NPI:1841266947
Name:BRADACH, KRISTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:BRADACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1440
Mailing Address - Country:US
Mailing Address - Phone:617-332-2047
Mailing Address - Fax:617-332-7341
Practice Address - Street 1:475 LOMBARD ST
Practice Address - Street 2:APT 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2464
Practice Address - Country:US
Practice Address - Phone:781-492-0492
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical