Provider Demographics
NPI:1487943114
Name:HEWARD, BRADY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:JOHN
Last Name:HEWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTH PROSPECT
Mailing Address - Street 2:ST. JOSEPH 3
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3456
Mailing Address - Country:US
Mailing Address - Phone:802-847-3333
Mailing Address - Fax:
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:VERMONT CENTER FOR CHILDREN, YOUTH & FAMILIES
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-7817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3006742084P0800X
CT0521732084P0800X
VT042.00131042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1027719Medicaid
CT008001325Medicaid
CT008022622Medicaid
CT004082260Medicaid
CT004217099Medicaid
CT008055441Medicaid