Provider Demographics
NPI:1124358312
Name:BRADY, TRACY ET (PSYD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ET
Last Name:BRADY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 MISSION ST
Mailing Address - Street 2:460
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2400
Mailing Address - Country:US
Mailing Address - Phone:415-715-1050
Mailing Address - Fax:
Practice Address - Street 1:1663 MISSION ST
Practice Address - Street 2:460
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2400
Practice Address - Country:US
Practice Address - Phone:415-715-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health