Provider Demographics
NPI:1215214861
Name:BRADY, CHRISTOPHER L (LMSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:BRADY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1246
Mailing Address - Country:US
Mailing Address - Phone:585-733-5530
Mailing Address - Fax:
Practice Address - Street 1:131 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1103
Practice Address - Country:US
Practice Address - Phone:585-733-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064983-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY064983-1Medicaid