Provider Demographics
NPI:1437259686
Name:BRODERICK, SHEILA EILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:EILEEN
Last Name:BRODERICK
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 1:1400 ARNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1604
Mailing Address - Country:US
Mailing Address - Phone:919-972-9958
Mailing Address - Fax:919-308-1709
Practice Address - Street 1:1400 ARNETTE AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1604
Practice Address - Country:US
Practice Address - Phone:919-972-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC651197169OtherUBH PROVIDER NUMBER
NC343264OtherMAMSI PROVIDER NUMBER
NC6002361Medicaid
NC130YHOtherBCBS PROVIDER NUMBER
NC651197169OtherCIGNA PROVIDER NUMBER
NC318282OtherMHN PROVIDER NUMBER
NC456981000OtherMAGELLAN PROVIDER NUMBER