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NPI Code Detail

MEDICARE: BRADY ROY

MEDICARE: BRADY ROY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCP 60628937WA
2101Y00000XCounselorCG61014249WA

General Provider Information

NPI Number : 1376098939
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADY ROY
Provider Business Mailing Address
First Line : 2212 S JACKSON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98144-2591
Country : US
Telephone Number : 206-322-2387
Fax Number :
Provider Business Practice Location Address
First Line : 2212 S JACKSON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98144-2591
Country : US
Telephone Number : 206-322-2387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2016
Last Update Date : 05/15/2025

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Directions to “ BRADY ROY ” Practice Location

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