Provider Demographics
NPI:1841434099
Name:BRADY, NANCY DIANE (MFT #38303 MASTERS I)
Entity type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:DIANE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MFT #38303 MASTERS I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SUNRISE BOULEVARD
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-863-2552
Mailing Address - Fax:
Practice Address - Street 1:5150 SUNRISE BOULEVARD
Practice Address - Street 2:SUITE D-3
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-863-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#38303(MARRIAGEFA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist