Provider Demographics
NPI:1053457705
Name:BRODY, DORA L (IMF)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:L
Last Name:BRODY
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MORENA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3843
Mailing Address - Country:US
Mailing Address - Phone:619-398-3261
Mailing Address - Fax:
Practice Address - Street 1:1202 MORENA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3843
Practice Address - Country:US
Practice Address - Phone:619-398-3261
Practice Address - Fax:619-275-2023
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist