MEDICARE: JENNIFER BRADY LICENSED CLINICAL SOCIAL WORKER PC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1891504874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER BRADY LICENSED CLINICAL SOCIAL WORKER PC

Provider Business Mailing Address
First Line	:	490 NOVARA WAY
Second Line	:
City	:	OAK PARK
State	:	CA
Zip	:	91377-5556
Country	:	US
Telephone Number	:	310-907-6580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 TOWNSGATE RD STE 520
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5712
Country	:	US
Telephone Number	:	310-907-6580
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER BRADY
Credential	:	LCSW
Telephone Number	:	310-907-6580

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	03/03/2025

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