Provider Demographics
NPI:1376740530
Name:BRODZINSKY, ANNE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:B
Last Name:BRODZINSKY
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 1:129 CALVERT CT
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3437
Mailing Address - Country:US
Mailing Address - Phone:510-985-1773
Mailing Address - Fax:510-985-1812
Practice Address - Street 1:129 CALVERT CT
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-3437
Practice Address - Country:US
Practice Address - Phone:510-985-1773
Practice Address - Fax:510-985-1812
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21157103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
823769Medicare ID - Type Unspecified