Provider Demographics
NPI:1003308131
Name:BRODERICK, NATALIE YVONNE (PH D PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:YVONNE
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:PH D PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7 STANLEY VILLAGE ROAD
Mailing Address - Street 2:BLOCK 5 FLAT 2C STANFORD VILLA
Mailing Address - City:STANLEY
Mailing Address - State:HONG KONG
Mailing Address - Zip Code:00000
Mailing Address - Country:HK
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 STANLEY VILLAGE ROAD
Practice Address - Street 2:BLOCK 5 FLAT 2C STANFORD VILLA
Practice Address - City:STANLEY
Practice Address - State:HONG KONG
Practice Address - Zip Code:00000
Practice Address - Country:HK
Practice Address - Phone:508-878-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical