Healthcare Provider Details

I. General information

NPI: 1609806322
Provider Name (Legal Business Name): JANE FRANCES BRODERICK-DANFORTH L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WALPOLE ST
NORWOOD MA
02062-3315
US

IV. Provider business mailing address

1 WALPOLE ST
NORWOOD MA
02062-3315
US

V. Phone/Fax

Practice location:
  • Phone: 508-238-7766
  • Fax: 508-230-5089
Mailing address:
  • Phone: 781-695-2630
  • Fax: 781-769-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1023151
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: