Provider Demographics
NPI:1871643114
Name:BRADY, ELAINE W (LMFT)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:W
Last Name:BRADY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 S. BASCOM AV.
Mailing Address - Street 2:STE. 130
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-637-1022
Mailing Address - Fax:
Practice Address - Street 1:1190 S. BASCOM AV.
Practice Address - Street 2:STE. 130
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-637-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMU 18214106H00000X
CALMFT18214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist