Provider Demographics
NPI:1124242060
Name:HAYCOCK, BRADY NICOLE (PSYD)
Entity type:Individual
Prefix:MS
First Name:BRADY
Middle Name:NICOLE
Last Name:HAYCOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 RHODE ISLAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001
Mailing Address - Country:US
Mailing Address - Phone:202-232-6100
Mailing Address - Fax:202-483-4560
Practice Address - Street 1:915 RHODE ISLAND AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:202-232-6100
Practice Address - Fax:202-483-4560
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCPSY1000577103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program