Provider Demographics
NPI:1609945054
Name:BRODIE, PAMELA JANE (PHD, LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:BRODIE
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E RIDGEWOOD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3846
Mailing Address - Country:US
Mailing Address - Phone:739-783-3030
Mailing Address - Fax:073-783-3033
Practice Address - Street 1:162 E RIDGEWOOD AVE STE 4
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3846
Practice Address - Country:US
Practice Address - Phone:973-783-3030
Practice Address - Fax:973-783-3033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00509200103TC0700X
NJ37PC00286500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical