Provider Demographics
NPI:1295075695
Name:BRODERICK, PATRICIA MCCARTHY (PHD, LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MCCARTHY
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LEA
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44691 WELLFLEET DR APT 306
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-2570
Mailing Address - Country:US
Mailing Address - Phone:703-608-8287
Mailing Address - Fax:
Practice Address - Street 1:21 FORT EVANS RD NE STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4488
Practice Address - Country:US
Practice Address - Phone:703-443-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004934101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor