Provider Demographics
NPI:1609806322
Name:BRODERICK-DANFORTH, JANE FRANCES (LICSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:FRANCES
Last Name:BRODERICK-DANFORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3315
Mailing Address - Country:US
Mailing Address - Phone:781-695-2630
Mailing Address - Fax:781-769-7008
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:508-238-7766
Practice Address - Fax:508-230-5089
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10231511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494539OtherTUFTS HEALTH PLAN
MAP08599OtherBC BS OF MASSACHUSETTS
MAP23665Medicare ID - Type UnspecifiedMASSACHUSETTS MEDICARE