Provider Demographics
NPI:1922379585
Name:BRADY, NOREEN F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NOREEN
Middle Name:F
Last Name:BRADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SPRINGMEADOW DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4101
Mailing Address - Country:US
Mailing Address - Phone:631-563-8354
Mailing Address - Fax:
Practice Address - Street 1:233 SPRINGMEADOW DR UNIT C
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4101
Practice Address - Country:US
Practice Address - Phone:631-563-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health