Provider Demographics
NPI:1023111960
Name:BRADY, MARILYN NEYER (PHD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:NEYER
Last Name:BRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:A
Other - Last Name:NEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:52171 BLAINE-BARTON ROAD ROUTE 10
Mailing Address - Street 2:PO BOX 655
Mailing Address - City:BARTON
Mailing Address - State:OH
Mailing Address - Zip Code:43905-0655
Mailing Address - Country:US
Mailing Address - Phone:740-695-1459
Mailing Address - Fax:
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3570
Practice Address - Fax:304-234-3511
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV751103T00000X
OH4940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001719064OtherBCBS
WV0300016000Medicaid
WVBRCP77083Medicare PIN
WVBRCP77084Medicare PIN
WV001719064OtherBCBS