MEDICARE: LEAH BRODT

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
1	103K00000X	Behavior Analyst	196006021	NY

General Provider Information

NPI Number	:	1952748592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH BRODT

Provider Business Mailing Address
First Line	:	1275 E 21ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 E 21ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4510
Country	:	US
Telephone Number	:	212-564-2350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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Directions to “ LEAH BRODT ” Practice Location

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