Provider Demographics
NPI:1932711538
Name:BRADSHER, JAZMINE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:ELIZABETH
Last Name:BRADSHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6967
Mailing Address - Country:US
Mailing Address - Phone:508-468-8737
Mailing Address - Fax:
Practice Address - Street 1:231 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4342
Practice Address - Country:US
Practice Address - Phone:508-468-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker