Provider Demographics
NPI:1164649992
Name:BRADY, ALISA (PHD)
Entity type:Individual
Prefix:MS
First Name:ALISA
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:DUCLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:785 GRAND AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2371
Mailing Address - Country:US
Mailing Address - Phone:760-793-8063
Mailing Address - Fax:
Practice Address - Street 1:785 GRAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2371
Practice Address - Country:US
Practice Address - Phone:760-793-8063
Practice Address - Fax:760-453-7055
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist