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General NPI Number Information
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NPI Number | 1790093771
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Entity Type | Individual
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Provider Name | MICHELLE BRODY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 9100 CONROY WINDERMERE RD STE 289
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City | WINDERMERE
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State | FL
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Zip | 34786-8431
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Country | US
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Telephone | 954-648-6699
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Fax |
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Provider Business Mailing Address
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Address Line | 12755 WOODBURY OAKS DR
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City | ORLANDO
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State | FL
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Zip | 32828-5914
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Country | US
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Telephone | 954-648-6699
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW8294
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License Number State | FL
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