Provider Demographics
NPI:1669724506
Name:BRODNICKI, CORINNE (MA LMFT)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:BRODNICKI
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 COLOMA WAY STE D
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4646
Mailing Address - Country:US
Mailing Address - Phone:916-407-4711
Mailing Address - Fax:
Practice Address - Street 1:1212 COLOMA WAY STE D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4646
Practice Address - Country:US
Practice Address - Phone:916-407-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist