Provider Demographics
NPI:1801136064
Name:BRADY, MARY (LCMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAMILY GUIDANCE CENTER OF MILFORD
Mailing Address - Street 2:16 ELM ST
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055
Mailing Address - Country:US
Mailing Address - Phone:603-672-5005
Mailing Address - Fax:603-628-7757
Practice Address - Street 1:FAMILY GUIDANCE CENTER OF MILFORD
Practice Address - Street 2:16 ELM ST
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055
Practice Address - Country:US
Practice Address - Phone:603-672-5005
Practice Address - Fax:603-628-7757
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1154302586Medicaid