Provider Demographics
NPI:1174182505
Name:MCDANIELS, BRADY
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:MCDANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 ALBERMARLE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1115
Mailing Address - Country:US
Mailing Address - Phone:609-577-5848
Mailing Address - Fax:
Practice Address - Street 1:504 ALBERMARLE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1115
Practice Address - Country:US
Practice Address - Phone:609-577-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist