Provider Demographics
NPI:1982914537
Name:BRODNICK, DAWN (LISW-SUPV)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BRODNICK
Suffix:
Gender:F
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 GRANGER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1979
Mailing Address - Country:US
Mailing Address - Phone:216-831-2555
Mailing Address - Fax:216-378-3906
Practice Address - Street 1:13201 GRANGER RD STE 8
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1979
Practice Address - Country:US
Practice Address - Phone:216-831-2555
Practice Address - Fax:216-378-3906
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005702-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid