Basic Information
| Provider Information | |||||||||
| NPI: | 1578572228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | ETHEL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | O'MEARA | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | ETHEL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1220 DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532132504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146476326 | ||||||||
| FaxNumber: | 4146718860 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 DEWEY AVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144546500 | ||||||||
| FaxNumber: | 4144546527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 417-124 | WI | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 3593-123 | WI | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 417 | WI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 1041C0700X | 3593 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.