Provider Demographics
NPI:1982973897
Name:BRADY, MARK A (MA, NBCT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BRADY
Suffix:
Gender:M
Credentials:MA, NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W. 47TH STREET
Mailing Address - Street 2:#4FW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2300
Mailing Address - Country:US
Mailing Address - Phone:646-469-1679
Mailing Address - Fax:
Practice Address - Street 1:418 W 47TH ST
Practice Address - Street 2:#4FW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2395
Practice Address - Country:US
Practice Address - Phone:646-469-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator