Provider Demographics
NPI:1811467814
Name:BRODERICK, MEGAN (LICSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 LACKAWANNA ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4531
Mailing Address - Country:US
Mailing Address - Phone:443-745-1763
Mailing Address - Fax:
Practice Address - Street 1:1101 CONN AVE NW STE 450
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4359
Practice Address - Country:US
Practice Address - Phone:202-368-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500817331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical