Provider Demographics
NPI:1427278381
Name:BROTBY, MELODY ANNE (MA)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANNE
Last Name:BROTBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 LONG CT
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6060
Mailing Address - Country:US
Mailing Address - Phone:805-495-5770
Mailing Address - Fax:
Practice Address - Street 1:68 LONG CT
Practice Address - Street 2:SUITE 1-D
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6060
Practice Address - Country:US
Practice Address - Phone:805-495-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist