| D.a.brodie,ph.d.p.c. | |
|
300 River Place Dr Ste 5350-g Detroit MI 48207-4457 | |
| (313) 871-1450 | |
| (313) 468-1105 |
| Full Name | D.a.brodie,ph.d.p.c. |
|---|---|
| Speciality | Psychologist |
| Location | 300 River Place Dr Ste 5350-g, Detroit, Michigan |
| Authorized Official Name and Position | Debra Ann Brodie (PRESIDENT) |
| Authorized Official Contact | 3138711450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D.a.brodie,ph.d.p.c. 300 River Place Dr Ste 5350-g Detroit MI 48207-4457 Ph: (313) 871-1450 | D.a.brodie,ph.d.p.c. 300 River Place Dr Ste 5350-g Detroit MI 48207-4457 Ph: (313) 871-1450 |
| NPI Number | 1710209010 |
|---|---|
| Provider Enumeration Date | 02/27/2010 |
| Last Update Date | 06/12/2021 |
| Certification Date | 06/12/2021 |
| Medicare PECOS PAC ID | 1153446349 |
|---|---|
| Medicare Enrollment ID | O20100910000908 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710209010 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301006340 (Michigan) | Primary |
| Provider Name | Debra A Brodie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518956259 PECOS PAC ID: 7810012010 Enrollment ID: I20100910001011 |
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