Individual provider Active NPI

Kevin Brady, PSY.D.

  • Psychologist
  • Glen Burnie, MD
National Provider Identifier
1669641668
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
04355 Issued in MD
Practice address
30 Greenway St NW Ste 5
Glen Burnie, MD 21061-3557
Phone
(410) 760-9079
Fax
(410) 760-1121
NPI assigned
Feb 22, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 04355 MD Primary

Addresses

Primary practice location

30 Greenway St NW Ste 5
Glen Burnie, MD 21061-3557

Mailing address

30 Greenway St NW
Suite 5
Glen Burnie, MD 21061-3557
Phone (410) 760-9079

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080609000576 MD Practitioner - Clinical Psychologist 3971673542 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oasis the Mental Health Center LLCGroup PAC ID 8527424837, 26 clinicians

Practice addresses (Care Compare)

30 Greenway St NW
Suite 5
Glen Burnie, MD 21061-3557
Phone (410) 760-9079

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
04355MDMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Baltimore Counseling Center, LLC CurrentSince Oct 1, 2007 Accepting new patients
Oasis the Mental Health Center, LLC CurrentSince Jun 1, 2023 Accepting new patients

Locations

175 Admiral Cochrane Dr
Ste 101B
Annapolis, MD 21401
Phone 41076090790

30 Greenway St NW
Ste 5
Glen Burnie, MD 21061
Phone 41076090790

1363 Becknel Ave
Odenton, MD 21113
Phone (240) 381-7900

1850 York Rd
Ste K
Timonium, MD 21093
Phone (410) 410-7609

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1669641668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 GREENWAY ST NW",
            "address_2": "SUITE 5",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613557",
            "telephone_number": "410-760-9079",
            "fax_number": "410-760-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 GREENWAY ST NW STE 5",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613557",
            "telephone_number": "410-760-9079",
            "fax_number": "410-760-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADY",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-22",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "04355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.