Doctor Name: | DR. JENNIFER A BRODERICK |
NPI Number: | 1003185372 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | PY8263 |
Business Practice Address: | 12938 Ablingdon Dr Frisco, TX - 75035 |
Business Phone Number: | 9545516352 |
Business Fax Number: | |
Mailing Address: | 12938 Ablingdon Dr, FRISCO |
State: | TX |
Postal Code: | 750358807 |
Phone Number: | 9545516352 |
Fax Number: | |
NPI Enumeration Date: | 12/15/2011 |
NPI Last Update Date: | 10/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY8263 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |