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General NPI Number Information
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NPI Number | 1063960912
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Entity Type | Individual
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Provider Name | NIRMALA BRODMAN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 500 8TH AVE 9TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10018-6504
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Country | US
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Telephone | 917-592-0426
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Fax |
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Provider Business Mailing Address
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Address Line | 355 MCDONALD AVE APT 3C
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City | BROOKLYN
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State | NY
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Zip | 11218-2264
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Country | US
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Telephone | 917-592-0426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 24439
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License Number State | NY
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