Provider Demographics
NPI:1588270854
Name:BRODSKY, JULIAN LYLE
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:LYLE
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 GOLDEN PARK PL APT C
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2444
Mailing Address - Country:US
Mailing Address - Phone:267-614-2837
Mailing Address - Fax:
Practice Address - Street 1:1015 GOLDEN PARK PL APT C
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-2444
Practice Address - Country:US
Practice Address - Phone:267-614-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional