Healthcare Provider Details

I. General information

NPI: 1891650081
Provider Name (Legal Business Name): STEPHANIE BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PETER JEFFERSON PKWY STE 130
CHARLOTTESVILLE VA
22911-4624
US

IV. Provider business mailing address

87 RIVERSIDE DR
PALMYRA VA
22963-2019
US

V. Phone/Fax

Practice location:
  • Phone: 434-448-3921
  • Fax:
Mailing address:
  • Phone: 434-448-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0903003042
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00947351
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: