Provider Demographics
NPI:1477667517
Name:BRADY, CHARLES F JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:BRADY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 MARINE DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2043
Mailing Address - Country:US
Mailing Address - Phone:360-234-4623
Mailing Address - Fax:360-234-4624
Practice Address - Street 1:509 4TH ST STE 28
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1401
Practice Address - Country:US
Practice Address - Phone:360-234-4623
Practice Address - Fax:360-234-4624
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908067Medicaid
OH0908067Medicaid
OHBRCP12671Medicare ID - Type Unspecified