Provider Demographics
NPI:1598134363
Name:BRODE, DANA (MSW/MHP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BRODE
Suffix:
Gender:F
Credentials:MSW/MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 4TH ST APT 2301
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-0027
Mailing Address - Country:US
Mailing Address - Phone:603-931-6467
Mailing Address - Fax:
Practice Address - Street 1:1700 E 4TH ST APT 2301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-0027
Practice Address - Country:US
Practice Address - Phone:603-931-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG 60577530101YM0800X
TX689051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health