Provider Demographics
NPI:1366167348
Name:BRADY, PATRICIA MARIA (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIA
Last Name:BRADY
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 JARVIS ST UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2295
Mailing Address - Country:US
Mailing Address - Phone:760-576-6500
Mailing Address - Fax:
Practice Address - Street 1:1315 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2107
Practice Address - Country:US
Practice Address - Phone:619-233-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952670333Medicaid