Provider Demographics
NPI:1114317609
Name:BRADY, THOMAS (LCSW MCAP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BRADY
Suffix:
Gender:M
Credentials:LCSW MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 14TH ST N STE 23
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4576
Mailing Address - Country:US
Mailing Address - Phone:239-234-6194
Mailing Address - Fax:
Practice Address - Street 1:2900 14TH ST N STE 23
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4576
Practice Address - Country:US
Practice Address - Phone:239-234-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12526101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)