Provider Demographics
NPI:1275798696
Name:CLEVENGER, BRADY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BRADY
Middle Name:
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E MCDOWELL RD
Mailing Address - Street 2:STE. 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2606
Mailing Address - Country:US
Mailing Address - Phone:602-944-4999
Mailing Address - Fax:
Practice Address - Street 1:1010 E MCDOWELL RD
Practice Address - Street 2:STE. 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2606
Practice Address - Country:US
Practice Address - Phone:602-944-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW125151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical