Provider Demographics
NPI:1720050552
Name:BRODIE, LESLEY THOMPSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:THOMPSON
Last Name:BRODIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9642
Mailing Address - Country:US
Mailing Address - Phone:802-392-2146
Mailing Address - Fax:802-367-1069
Practice Address - Street 1:82 ELM STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255
Practice Address - Country:US
Practice Address - Phone:802-367-1068
Practice Address - Fax:802-367-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57553361205208000000X, 2084P0800X, 2084P0804X
NY261723-012084P0800X, 2084P0804X
VT042-00121502084P0800X, 2084P0804X
MA2870482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019286Medicaid