Provider Demographics
NPI:1073741476
Name:BRODY, CATHY STANLEY (MFT)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:STANLEY
Last Name:BRODY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CAPISTRANO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-7218
Mailing Address - Country:US
Mailing Address - Phone:805-461-3987
Mailing Address - Fax:805-461-4124
Practice Address - Street 1:5805 CAPISTRANO AVE STE A
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7218
Practice Address - Country:US
Practice Address - Phone:805-461-3987
Practice Address - Fax:880-546-1412
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist