Provider Demographics
NPI:1336205467
Name:BRADY, ELINOR C (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELINOR
Middle Name:C
Last Name:BRADY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3718
Mailing Address - Country:US
Mailing Address - Phone:781-444-2110
Mailing Address - Fax:
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:781-769-8779
Practice Address - Fax:781-769-7008
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03167Medicare ID - Type Unspecified