Provider Demographics
NPI:1427418094
Name:BRADY, SARAH (MSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 OAKLAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1116
Mailing Address - Country:US
Mailing Address - Phone:269-323-4473
Mailing Address - Fax:269-324-0755
Practice Address - Street 1:5717 OAKLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1116
Practice Address - Country:US
Practice Address - Phone:269-323-4473
Practice Address - Fax:269-324-0755
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090582104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker