| Doctor Name: | MATTHEW STUART BROUDY |
| NPI Number: | 1649348145 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 0810003712 |
| Business Practice Address: | 2239f Tacketts Mill Drive Lake Ridge, VA - 22192 |
| Business Phone Number: | 7034900336 |
| Business Fax Number: | 7034904525 |
| Mailing Address: | 2239f Tacketts Mill Drive, LAKE RIDGE |
| State: | VA |
| Postal Code: | 22192 |
| Phone Number: | 7034900336 |
| Fax Number: | 7034904525 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810003712 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |