Healthcare Provider Details

I. General information

NPI: 1205434438
Provider Name (Legal Business Name): ELIANNAH GABRIELLE BRADY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIANNAH GABRIELLE DE CARLO PSYD

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ERIE AVE
PHILADELPHIA PA
19134-1011
US

IV. Provider business mailing address

PO BOX 13579
PHILADELPHIA PA
19101-3579
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-8363
  • Fax:
Mailing address:
  • Phone: 484-628-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS019788
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: