Provider Demographics
NPI:1598063398
Name:BRODIE, FELECIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:L
Last Name:BRODIE
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 1:542 BERLIN CROSSKEYS RD # 3
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4367
Mailing Address - Country:US
Mailing Address - Phone:215-620-5516
Mailing Address - Fax:856-262-1422
Practice Address - Street 1:542 BERLIN CROSS KEYS RD
Practice Address - Street 2:#3, SUITE 201
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4367
Practice Address - Country:US
Practice Address - Phone:215-620-5516
Practice Address - Fax:856-262-1422
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO53274001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical