Provider Demographics
NPI:1891086492
Name:BRODIE, CYNTHIA DIANNE
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:BRODIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-4538
Mailing Address - Country:US
Mailing Address - Phone:928-344-8800
Mailing Address - Fax:928-344-8837
Practice Address - Street 1:3780 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-4538
Practice Address - Country:US
Practice Address - Phone:928-344-8800
Practice Address - Fax:928-344-8837
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency