Provider Demographics
NPI:1972904902
Name:BRODZIAK, KERRY (LICSW)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:BRODZIAK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WATER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4807
Mailing Address - Country:US
Mailing Address - Phone:781-641-5800
Mailing Address - Fax:
Practice Address - Street 1:5 WATER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4807
Practice Address - Country:US
Practice Address - Phone:781-641-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW 219102-21041C0700X
MA1193731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical