Provider Demographics
NPI:1225190796
Name:BRODSKY, IMOGENE HAYS (LCSW)
Entity Type:Individual
Prefix:
First Name:IMOGENE
Middle Name:HAYS
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 MARLOS DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6919
Mailing Address - Country:US
Mailing Address - Phone:678-494-7037
Mailing Address - Fax:
Practice Address - Street 1:122 CHERRY ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7206
Practice Address - Country:US
Practice Address - Phone:678-993-3767
Practice Address - Fax:770-422-2302
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical