Provider Demographics
NPI:1922247394
Name:BRODIE, ROBERT S (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BRODIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PARKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1450
Mailing Address - Country:US
Mailing Address - Phone:845-709-5325
Mailing Address - Fax:845-354-9432
Practice Address - Street 1:64 PARKER BLVD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1450
Practice Address - Country:US
Practice Address - Phone:845-709-5325
Practice Address - Fax:845-354-9432
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078533-1104100000X
NY079474-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker