Provider Demographics
NPI:1588724652
Name:BRODIE, CARLIN M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARLIN
Middle Name:M
Last Name:BRODIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CARLIN
Other - Middle Name:M
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12608 NICHOLS PROMISE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5602
Mailing Address - Country:US
Mailing Address - Phone:301-860-1073
Mailing Address - Fax:
Practice Address - Street 1:720 N SAINT ASAPH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1912
Practice Address - Country:US
Practice Address - Phone:703-838-6400
Practice Address - Fax:703-838-5070
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040035241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0086OtherCARE FIRST BCBS
VA011455A25Medicare ID - Type Unspecified