Broderick, Mary Ellen
Broderick, Mary Ellen is an individual health care provider with primary practice located at 2902 Madison St , Marianna FL 32446-3450. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Broderick, Mary Ellen can be contacted via phone (850) 482-8830.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PY 3181 | Florida |
Profile Details
| NPI number | 1356484240 |
|---|---|
| LBN Legal business name | Broderick, Mary Ellen |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 14th, 2007 |
| 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 | 1356484240 | NPPES |
| Florida | Other | 75290 | BCBS PSYCHOLOGIST |
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