| Doctor Name: | BERTINA BRADSHAW |
| NPI Number: | 1043593809 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 161039939 |
| Business Practice Address: | 571 St. Joseph's Blvd. Suite 102 Elmira, NY - 149013230 |
| Business Phone Number: | 6077375215 |
| Business Fax Number: | |
| Mailing Address: | 571 St. Joseph's Blvd., Suite 102 ELMIRA |
| State: | NY |
| Postal Code: | 149013230 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2011 |
| NPI Last Update Date: | 09/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 161039939 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |