Provider Demographics
NPI:1104242627
Name:BRADY, ELIZABETH (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-5156
Mailing Address - Country:US
Mailing Address - Phone:339-223-7371
Mailing Address - Fax:703-852-3029
Practice Address - Street 1:11905 BOWMAN DR STE 507
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7344
Practice Address - Country:US
Practice Address - Phone:540-395-9962
Practice Address - Fax:703-852-3029
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-13-14294103K00000X
VA0133000901103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty