Provider Demographics
NPI:1770205510
Name:BRADY, NOAH ABRAHAM
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:ABRAHAM
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3120
Mailing Address - Country:US
Mailing Address - Phone:360-670-3219
Mailing Address - Fax:
Practice Address - Street 1:716 S CHASE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6122
Practice Address - Country:US
Practice Address - Phone:360-395-2976
Practice Address - Fax:360-395-2977
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61248021106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician