Provider Demographics
NPI:1205672250
Name:BRADY-ROGERS, MOIRA-CECILY (LMFT)
Entity type:Individual
Prefix:
First Name:MOIRA-CECILY
Middle Name:
Last Name:BRADY-ROGERS
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 1:1000 FREMONT AVE STE 281
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3225
Mailing Address - Country:US
Mailing Address - Phone:626-254-1724
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 218
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3225
Practice Address - Country:US
Practice Address - Phone:626-254-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist