| Organization Name: | LESLEY BRODIE, M.D., P.C. |
| NPI Number: | 1114347440 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LESLEY THOMPSON BRODIE (OFFICER/MEMBER) |
| Mailing Address: | 82 Elm Street Manchester Center |
| State: | VT US |
| Postal Code: | 052559642 |
| Phone Number: | 8023671068 |
| Fax Number: | 8023671069 |
| NPI Enumeration Date: | 04/25/2014 |
| NPI Last Update Date: | 04/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | 042.0012150 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |