Provider Demographics
NPI:1821412453
Name:VEGA-BRADY, NANCY (MA, LMHC-12071)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:VEGA-BRADY
Suffix:
Gender:F
Credentials:MA, LMHC-12071
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 SUNTREE BLVD STE 2207
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7558
Mailing Address - Country:US
Mailing Address - Phone:321-757-4029
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD STE 2207
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7558
Practice Address - Country:US
Practice Address - Phone:321-757-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health