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NPI Code Detail

MEDICARE: MR. BRADFORD CLARK BRODEUR MA., M.DIV.

MEDICARE:  MR. BRADFORD CLARK BRODEUR  MA., M.DIV.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor001569MD

General Provider Information

NPI Number : 1417284241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADFORD CLARK BRODEUR MA., M.DIV.
Provider Business Mailing Address
First Line : 8901 NEW HAMPSHIRE AVE
Second Line :
City : SILVER SPRING
State : MD
Zip : 20903-3611
Country : US
Telephone Number : 301-422-5438
Fax Number :
Provider Business Practice Location Address
First Line : 8901 NEW HAMPSHIRE AVE
Second Line :
City : SILVER SPRING
State : MD
Zip : 20903-3611
Country : US
Telephone Number : 301-422-5438
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2009
Last Update Date : 11/16/2009

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Directions to “ MR. BRADFORD CLARK BRODEUR MA., M.DIV.” Practice Location

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