Provider Demographics
NPI:1518011998
Name:GEORGE S BRODERICK D.O. INC.
Entity Type:Organization
Organization Name:GEORGE S BRODERICK D.O. INC.
Other - Org Name:GREATER CINCINNATI PSYCHIATRIC AND COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-553-0414
Mailing Address - Street 1:4030 MOUNT CARMEL TOBASCO RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3400
Mailing Address - Country:US
Mailing Address - Phone:513-528-9200
Mailing Address - Fax:513-528-9202
Practice Address - Street 1:4030 MOUNT CARMEL TOBASCO RD
Practice Address - Street 2:SUITE 314
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3400
Practice Address - Country:US
Practice Address - Phone:513-528-9200
Practice Address - Fax:513-528-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007182B2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGR9309381Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER