Provider Demographics
NPI:1104218049
Name:BRODSKY, KIM (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DIANNE AVE
Mailing Address - Street 2:COTTAGE
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3635
Mailing Address - Country:US
Mailing Address - Phone:631-648-9905
Mailing Address - Fax:
Practice Address - Street 1:900 WHEELER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2964
Practice Address - Country:US
Practice Address - Phone:631-361-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYES43470104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker