Provider Demographics
NPI:1336416759
Name:KRIEG-BRADY, CAROLINE AMANDA
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:AMANDA
Last Name:KRIEG-BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ELM STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-734-0300
Mailing Address - Fax:
Practice Address - Street 1:1111 ELM ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1782
Practice Address - Country:US
Practice Address - Phone:413-734-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst