Provider Demographics
NPI:1679639249
Name:BRODSKY, HARRIET A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:A
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 NORCROSS ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7409
Mailing Address - Country:US
Mailing Address - Phone:770-640-8989
Mailing Address - Fax:770-993-3669
Practice Address - Street 1:12 NORCROSS ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7409
Practice Address - Country:US
Practice Address - Phone:770-640-8989
Practice Address - Fax:770-993-3669
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00793075DMedicaid