Provider Demographics
NPI:1568796787
Name:BRADY, JEFFERY LAMONT SR (MHS)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:LAMONT
Last Name:BRADY
Suffix:SR
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 CHARLES TER
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5704
Mailing Address - Country:US
Mailing Address - Phone:610-453-7204
Mailing Address - Fax:
Practice Address - Street 1:9 HARDING HWY
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4401
Practice Address - Country:US
Practice Address - Phone:856-358-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)