Provider Demographics
NPI:1225361306
Name:BRODSKY, KIMBERLY L (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1320
Mailing Address - Country:US
Mailing Address - Phone:720-530-9622
Mailing Address - Fax:
Practice Address - Street 1:1635 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1320
Practice Address - Country:US
Practice Address - Phone:720-530-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical