Provider Demographics
NPI:1578572228
Name:BRADY, KATHLEEN ETHEL (LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ETHEL
Last Name:BRADY
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ETHEL
Other - Last Name:O'MEARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2504
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:BLDG 2
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213
Practice Address - Country:US
Practice Address - Phone:414-454-6500
Practice Address - Fax:414-454-6527
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI417-124101Y00000X
WI3593-123101Y00000X
WI417106H00000X
WI35931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist