Provider Demographics
NPI:1972984615
Name:BRODARICK, JAMIE N (PHD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:N
Last Name:BRODARICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 CATESBY ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7271
Mailing Address - Country:US
Mailing Address - Phone:561-213-9803
Mailing Address - Fax:
Practice Address - Street 1:7777 GLADES RD STE 207B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4150
Practice Address - Country:US
Practice Address - Phone:561-213-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist