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:
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Health care specialties

SpecialtyCodeLicense #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 19 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699716217 NPPES
New York MEDICAID 00663194

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