Healthcare Provider Details

I. General information

NPI: 1295075695
Provider Name (Legal Business Name): PATRICIA MCCARTHY BRODERICK PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA LEA MCCARTHY PHD LPC

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S RANDOLPH ST RM 7
LEXINGTON VA
24450-2328
US

IV. Provider business mailing address

47 MEADOWOOD LN
RAPHINE VA
24472-2126
US

V. Phone/Fax

Practice location:
  • Phone: 703-608-8287
  • Fax:
Mailing address:
  • Phone: 703-608-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004934
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701004934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: