Provider Demographics
NPI:1730314147
Name:MCDONALD, SYDNEY BRODEUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:BRODEUR
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 W GRACE ST
Mailing Address - Street 2:#108
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1832
Mailing Address - Country:US
Mailing Address - Phone:205-910-5026
Mailing Address - Fax:804-828-6099
Practice Address - Street 1:5700 W GRACE ST
Practice Address - Street 2:#108
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1832
Practice Address - Country:US
Practice Address - Phone:205-910-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004050103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist