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1205434438 NPI number — ELIANNAH GABRIELLE BRADY PSYD

NPI Number: 1205434438
Health Care Provider/Practitioner: ELIANNAH GABRIELLE BRADY PSYD

Information about “1205434438” NPI (ELIANNAH GABRIELLE BRADY PSYD) exists in 1205434438 in HTML format HTML  |  1205434438 in plain Text format TXT  |  1205434438 in PDF (Portable Document Format) PDF  |  1205434438 in an XML format XML  formats.

NPI Number : 1205434438 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205434438",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRADY",
    "FirstName": "ELIANNAH",
    "MiddleName": "GABRIELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DE CARLO",
    "OtherFirstName": "ELIANNAH",
    "OtherMiddleName": "GABRIELLE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PSYD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 13579",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PHILADELPHIA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19101-3579",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "484-628-1324",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "160 E ERIE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHILADELPHIA",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19134-1011",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "215-427-8363",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/09/2020",
    "LastUpdateDate": "05/21/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103T00000X",
        "TaxonomyName": "Psychologist",
        "LicenseNumber": "PS019788",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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