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General NPI Number Information
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NPI Number | 1972984615
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Entity Type | Individual
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Provider Name | JAMIE N. BRODARICK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 09/19/2015
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Provider Practice Location Address
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Address Line | 7777 GLADES RD STE 207B
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City | BOCA RATON
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State | FL
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Zip | 33434-4150
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Country | US
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Telephone | 561-213-9803
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Fax |
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Provider Business Mailing Address
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Address Line | 5955 CATESBY ST
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City | BOCA RATON
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State | FL
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Zip | 33433-7271
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Country | US
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Telephone | 561-213-9803
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2817
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License Number State | FL
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