Provider Demographics
NPI:1043471501
Name:BRADY, JENNIFER LYNN (LCPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PAZDERKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC-AD
Mailing Address - Street 1:1223 TILLERMAN PL
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL COVE
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2225
Mailing Address - Country:US
Mailing Address - Phone:410-303-3438
Mailing Address - Fax:410-768-6444
Practice Address - Street 1:877 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4700
Practice Address - Country:US
Practice Address - Phone:410-303-3438
Practice Address - Fax:410-705-0535
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional