Provider Demographics
NPI:1952448086
Name:BRADY, VIRGINIA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:J
Last Name:BRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 STARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-5658
Mailing Address - Country:US
Mailing Address - Phone:940-262-0383
Mailing Address - Fax:
Practice Address - Street 1:9109 STARWOOD LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-5658
Practice Address - Country:US
Practice Address - Phone:940-262-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical