Provider Demographics
NPI:1073611141
Name:BRODNER, CINDY (MA, CEAP, LPC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BRODNER
Suffix:
Gender:F
Credentials:MA, CEAP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 SE HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4147
Mailing Address - Country:US
Mailing Address - Phone:503-261-0600
Mailing Address - Fax:
Practice Address - Street 1:2928 SE HAWTHORNE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4147
Practice Address - Country:US
Practice Address - Phone:503-261-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health