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General NPI Number Information
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NPI Number | 1467909556
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Entity Type | Individual
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Provider Name | DOUGLAS M BRODMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 333 E 43RD ST LBBY 1
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City | NEW YORK
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State | NY
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Zip | 10017-4819
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Country | US
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Telephone | 917-599-7743
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Fax |
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Provider Business Mailing Address
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Address Line | 577 2ND AVE APT 56
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City | NEW YORK
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State | NY
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Zip | 10016-6349
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Country | US
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Telephone | 917-599-7743
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021902
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License Number State | NY
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