Provider Demographics
NPI:1871617258
Name:BRADY, CHRISTOPHER B (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:BRADY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:(151C)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-2596
Mailing Address - Fax:857-364-4544
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:(151C)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-2596
Practice Address - Fax:857-364-4544
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7798103G00000X, 103TC0700X, 261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical