Provider Demographics
NPI:1528422904
Name:BRODSKY, RICHARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 HILL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1520
Mailing Address - Country:US
Mailing Address - Phone:914-206-9618
Mailing Address - Fax:914-206-9618
Practice Address - Street 1:3630 HILL BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1520
Practice Address - Country:US
Practice Address - Phone:914-206-9618
Practice Address - Fax:914-206-9618
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015306-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist