Provider Demographics
NPI:1710209010
Name:D.A.BRODIE,PH.D.P.C.
Entity Type:Organization
Organization Name:D.A.BRODIE,PH.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-871-1450
Mailing Address - Street 1:300 RIVER PLACE DR STE 5350-G
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4457
Mailing Address - Country:US
Mailing Address - Phone:313-871-1450
Mailing Address - Fax:313-468-1105
Practice Address - Street 1:300 RIVER PLACE DR STE 5350-G
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4457
Practice Address - Country:US
Practice Address - Phone:313-871-1450
Practice Address - Fax:313-468-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-27
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty