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General NPI Number Information
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NPI Number | 1396910717
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Entity Type | Individual
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Provider Name | ROCHELLE MARSHA BRODER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2008
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Last Update Date | 04/26/2008
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Provider Practice Location Address
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Address Line | 10515 LINCOLN DR
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1542
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Country | US
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Telephone | 248-227-2568
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Fax | 248-399-7356
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Provider Business Mailing Address
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Address Line | 10515 LINCOLN DR
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1542
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Country | US
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Telephone | 248-227-2568
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Fax | 248-399-7356
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301012695
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License Number State | MI
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