Provider Demographics
NPI:1194938613
Name:BRODIE, JANIS ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:ELLEN
Last Name:BRODIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 W 72ND ST
Mailing Address - Street 2:#12D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2713
Mailing Address - Country:US
Mailing Address - Phone:212-877-2568
Mailing Address - Fax:212-877-2568
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:STE. 307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-877-2568
Practice Address - Fax:212-877-2568
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013988-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN28931Medicare UPIN