Individual
BERTINA BRADSHAW
Active
Individual
BERTINA BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
161039939
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023054376
—
NY
Enumeration date
09/27/2011
Last updated
09/27/2011
Update your record
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