Provider Demographics
NPI:1457400657
Name:NORMAN BROUDY
Entity Type:Organization
Organization Name:NORMAN BROUDY
Other - Org Name:NORMAN BROUDY AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-655-7110
Mailing Address - Street 1:825 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1509
Mailing Address - Country:US
Mailing Address - Phone:302-655-7110
Mailing Address - Fax:302-655-7378
Practice Address - Street 1:825 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1509
Practice Address - Country:US
Practice Address - Phone:302-655-7110
Practice Address - Fax:302-655-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000473103T00000X
DEB10000333103T00000X
DEB10000381103T00000X
DEB10000110103T00000X
DEB10000234103T00000X
DELE0000140103TC0700X
DEC10006767103TC0700X
DEC10007596103TC0700X
DEC10001649103TC0700X
DEQ10000120104100000X
DEQ10000260104100000X
DEQ10000773104100000X
DEQ10000129104100000X
DEPC0000237104100000X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPC0000224OtherSTATE LICENSE NUMBER
DEB10000381OtherSTATE LICENSE NUMBER
DEQ10000129OtherSTATE LICENSE NUMBER
DEQ10000120OtherSTATE LICENSE NUMBER
DEC10001649OtherSTATE LICENSE NUMBER
DEQ10000260OtherSTATE LICENSE NUMBER
DEQ10000773OtherSTATE LICENSE NUMBER
DEC10006767OtherSTATE LICENSE NUMBER
DEC10007596OtherSTATE LICENSE NUMBER
DEPC0000237OtherSTATE LICENSE NUMBER
DEB10000110OtherSTATE LICENSE NUMBER
DEB10000333OtherSTATE LICENSE NUMBER
DELE0000140OtherSTATE LICENSE NUMBER
DEPC0000003OtherSTATE LICENSE NUMBER
DE0000473OtherSTATE LICENSE NUMBER
DEB10000234OtherSTATE LICENSE NUMBER