Provider Demographics
NPI:1104987403
Name:BRODER, STEVEN N (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:N
Last Name:BRODER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 DEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3413
Mailing Address - Country:US
Mailing Address - Phone:617-527-0139
Mailing Address - Fax:
Practice Address - Street 1:853 DEDHAM ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3413
Practice Address - Country:US
Practice Address - Phone:617-527-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2854103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W02985Medicare UPIN
MAW02985Medicare ID - Type Unspecified