Provider Demographics
NPI:1639371909
Name:CAROLL M BRODSKY, M.D.
Entity Type:Organization
Organization Name:CAROLL M BRODSKY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-566-6300
Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3608
Mailing Address - Country:US
Mailing Address - Phone:415-566-6300
Mailing Address - Fax:415-566-6301
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-566-6300
Practice Address - Fax:415-566-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17726103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty