Healthcare Provider Details

I. General information

NPI: 1861322802
Provider Name (Legal Business Name): LILLY BRODIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 N BROADWAY STE 2-8
RED HOOK NY
12571-1463
US

IV. Provider business mailing address

PO BOX 53
TIVOLI NY
12583-0053
US

V. Phone/Fax

Practice location:
  • Phone: 562-362-9385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: