Provider Demographics
NPI:1457186397
Name:WILSON, BRADY MICHAEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:BRADY
Middle Name:MICHAEL
Last Name:WILSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HOWARD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2387
Mailing Address - Country:US
Mailing Address - Phone:814-312-0471
Mailing Address - Fax:
Practice Address - Street 1:191 HOWARD ST STE 210
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2387
Practice Address - Country:US
Practice Address - Phone:814-312-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker