Provider Demographics
NPI:1922599794
Name:JOYCE-BRADY, JEAN MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:JOYCE-BRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3906
Mailing Address - Country:US
Mailing Address - Phone:781-774-9718
Mailing Address - Fax:
Practice Address - Street 1:73 TREMONT ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3916
Practice Address - Country:US
Practice Address - Phone:617-573-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3479-PY-PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist