Provider Demographics
NPI:1568573459
Name:BRADY, PATRICK J
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY RD # 7440
Mailing Address - Street 2:COMMANDER USA-MEDDAC-AK, ATTN:MCUC-MMD-QM
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5001
Mailing Address - Country:US
Mailing Address - Phone:907-353-5418
Mailing Address - Fax:907-353-4847
Practice Address - Street 1:1060 GAFFNEY RD # 7440
Practice Address - Street 2:COMMANDER USA-MEDDAC-AK, ATTN:MCUC-MMD-QM
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5001
Practice Address - Country:US
Practice Address - Phone:907-353-5418
Practice Address - Fax:907-353-4847
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist