E Peabody Bradford, PH.D.
Individual provider Active NPI Clinical Psychologist · Sonoma, CA
NPI 1851423396 · NPPES record last updated Sep 2, 2018
Key facts
- NPI
- 1851423396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY19656 (CA)
- Practice address
- 620 Broadway
Sonoma, CA 95476 - Phone
- (415) 385-2806
- NPI assigned
- Mar 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
620 Broadway
Sonoma, CA 95476-7002
Phone (415) 385-2806
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080611000303 | CA | Practitioner - Clinical Psychologist | 5092886523 | Practice locations: Sonoma, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19656 | CA | MD | Clinical Psychologist |
| 19656 | CA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY19656 | CA | Yes |
Addresses
Primary practice location
620 Broadway
Sonoma, CA 95476
Mailing address
PO Box 404
San Francisco, CA 95476
Phone (415) 385-2806
Other providers in Sonoma, CA
- Roberta Ann Bostian
- John Gifford Boyce-Smith
- Wendy M Boyer
- Tyler Tilden Boynton
- Bradd S. Yoshioka, a Dental Corporation
- Marcy Swiatek Brandner
- Sara Brashear
- Steven Brewer
- Elaine Briefman
- Leslie Brooke
All providers in Sonoma, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.