Provider Demographics
NPI:1093870131
Name:BRODY, EVE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:M
Last Name:BRODY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:SUITE 8H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8183
Mailing Address - Country:US
Mailing Address - Phone:212-593-2686
Mailing Address - Fax:212-593-2690
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:SUITE 8H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8183
Practice Address - Country:US
Practice Address - Phone:212-593-2686
Practice Address - Fax:212-593-2690
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011389-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8A891Medicare ID - Type Unspecified