Provider Demographics
NPI:1225584220
Name:BRADY, BRIAN (BCBA-D)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BRADY
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FOE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4646
Mailing Address - Country:US
Mailing Address - Phone:925-752-2119
Mailing Address - Fax:
Practice Address - Street 1:135 FOE CREEK CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4646
Practice Address - Country:US
Practice Address - Phone:925-752-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-21048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst