Healthcare Provider Details

I. General information

NPI: 1629117635
Provider Name (Legal Business Name): MICHAEL BRADY LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EAST ST BRIEN CENTER
PITTSFIELD MA
01201-5312
US

IV. Provider business mailing address

PO BOX 929
LANESBORO MA
01237-0929
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-0412
  • Fax: 413-499-0995
Mailing address:
  • Phone: 413-499-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1547
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: