1003308131 NPI number — DR. NATALIE YVONNE BRODERICK PH. D. PSYCHOLOGIST

Table of content: DR. NATALIE YVONNE BRODERICK PH. D. PSYCHOLOGIST (NPI 1003308131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003308131 NPI number — DR. NATALIE YVONNE BRODERICK PH. D. PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRODERICK
Provider First Name:
NATALIE
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH. D. PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003308131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 STANLEY VILLAGE ROAD
Provider Second Line Business Mailing Address:
BLOCK 5 FLAT 2C STANFORD VILLA
Provider Business Mailing Address City Name:
STANLEY
Provider Business Mailing Address State Name:
HONG KONG
Provider Business Mailing Address Postal Code:
00000
Provider Business Mailing Address Country Code:
HK
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 STANLEY VILLAGE ROAD
Provider Second Line Business Practice Location Address:
BLOCK 5 FLAT 2C STANFORD VILLA
Provider Business Practice Location Address City Name:
STANLEY
Provider Business Practice Location Address State Name:
HONG KONG
Provider Business Practice Location Address Postal Code:
00000
Provider Business Practice Location Address Country Code:
HK
Provider Business Practice Location Address Telephone Number:
508-878-1622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  8026 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)