1457564700 NPI number — JUDITH BRODSKY LIST JUDITH BRODSKY LIST

Table of content: JUDITH BRODSKY LIST JUDITH BRODSKY LIST (NPI 1457564700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457564700 NPI number — JUDITH BRODSKY LIST JUDITH BRODSKY LIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIST
Provider First Name:
JUDITH
Provider Middle Name:
BRODSKY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
JUDITH BRODSKY LIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIST
Provider Other First Name:
JUDITH
Provider Other Middle Name:
BRODSKY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457564700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11042 SEVEN HILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-299-4135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4919 BETHESDA AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-656-3644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4999 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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