Provider Demographics
NPI:1164433819
Name:DEGRASSE, BRADY MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRADY
Middle Name:MICHAEL
Last Name:DEGRASSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CORONADO PL
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-3914
Mailing Address - Country:US
Mailing Address - Phone:850-890-5352
Mailing Address - Fax:
Practice Address - Street 1:308 CORONADO PL
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-3914
Practice Address - Country:US
Practice Address - Phone:850-890-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100771041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical