Broderick, Joan
Broderick, Joan is an individual health care provider with primary practice located at Suny Putnam Hall Rm 103 , Stony Brook NY 11794-0001. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Broderick, Joan can be contacted via phone (631) 632-3106.Contact Information
Primary practice address
Suny Putnam Hall Rm 103
Stony Brook NY 11794-0001
Phone: (631) 632-3106
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 006567 | New York |
Profile Details
| NPI number | 1699716217 |
|---|---|
| LBN Legal business name | Broderick, Joan |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 8th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699716217 | NPPES |
| New York | MEDICAID | 00663194 |
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