Healthcare Provider Details

I. General information

NPI: 1245352590
Provider Name (Legal Business Name): ANNMARIE BRADY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MAPLE ST STE 201
DANVERS MA
01923-4065
US

IV. Provider business mailing address

480 MAPLE ST STE 201
DANVERS MA
01923-4065
US

V. Phone/Fax

Practice location:
  • Phone: 978-646-7070
  • Fax:
Mailing address:
  • Phone: 978-646-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106446
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: