Provider Demographics
NPI:1003047648
Name:BRADY, ANNE M (LISW-S)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:BRADY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OLD HENDERSON RD STE W227
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-7607
Mailing Address - Country:US
Mailing Address - Phone:614-585-9355
Mailing Address - Fax:
Practice Address - Street 1:1550 OLD HENDERSON RD STE W227
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7607
Practice Address - Country:US
Practice Address - Phone:614-585-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid