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General NPI Number Information
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NPI Number | 1710209010
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Entity Type | Organization
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Legal Business Name | D.A.BRODIE,PH.D.P.C.
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Dates
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Enumeration Date | 02/27/2010
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Last Update Date | 06/12/2021
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Provider Practice Location Address
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Address Line | 300 RIVER PLACE DR STE 5350-G
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City | DETROIT
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State | MI
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Zip | 48207-4457
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Country | US
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Telephone | 313-871-1450
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Fax | 313-468-1105
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Provider Business Mailing Address
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Address Line | 300 RIVER PLACE DR STE 5350-G
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City | DETROIT
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State | MI
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Zip | 48207-4457
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Country | US
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Telephone | 313-871-1450
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Fax | 313-468-1105
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBRA ANN BRODIE
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Credential | PH.D.
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Telephone | 313-871-1450
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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 | 6301006340
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License Number State | MI
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