Provider Demographics
NPI:1871036905
Name:BRODY, STEVEN (MFT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:BRODY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9654 MARDELLE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2431
Mailing Address - Country:US
Mailing Address - Phone:916-714-2864
Mailing Address - Fax:
Practice Address - Street 1:9654 MARDELLE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2431
Practice Address - Country:US
Practice Address - Phone:916-714-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist