Provider Demographics
NPI:1679869382
Name:BRADY, AUDREY WILCOX (MSW)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:WILCOX
Last Name:BRADY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 VICTORIA BLVD
Mailing Address - Street 2:LOWER APT.
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2217
Mailing Address - Country:US
Mailing Address - Phone:585-344-1421
Mailing Address - Fax:
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:SUITE # 2
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLIMITED EN ROUTE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical