Provider Demographics
NPI:1386847952
Name:BRODY, STEVE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:BRODY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 SANTA ROSA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-3526
Mailing Address - Country:US
Mailing Address - Phone:805-927-5020
Mailing Address - Fax:
Practice Address - Street 1:800 HILLCREST DR STE 7
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-2840
Practice Address - Country:US
Practice Address - Phone:805-927-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical