# LESLEY BRODIE, M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114347440
- **Authorized official:** DR. LESLEY THOMPSON BRODIE M.D. (OFFICER/MEMBER)
- **Authorized official phone:** (802) 367-1068

## Contact information

- **Practice address:** 82 ELM STREET, MANCHESTER CENTER, VT 05255-9642
- **Practice address phone:** (802) 367-1068
- **Practice address fax:** (802) 367-1069
- **Mailing address:** PO BOX 766, MANCHESTER, VT 05254-0766
- **Mailing address phone:** (802) 367-1068
- **Mailing address fax:** (802) 367-1069

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | 042.0012150 | VT | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 042.0012150 | VT | Yes |

## Other

- **Enumeration date:** 04/25/2014
- **Last updated:** 04/25/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1019286 | — | VT |