Healthcare Provider Details

I. General information

NPI: 1629759733
Provider Name (Legal Business Name): JOHN BRADY CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NJ-35
CLIFFWOOD NJ
07721
US

IV. Provider business mailing address

319 DELAWARE DR
BRICK NJ
08723-5977
US

V. Phone/Fax

Practice location:
  • Phone: 732-812-5489
  • Fax:
Mailing address:
  • Phone: 732-241-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00158200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: