Organization
CANTWELL FAMILY PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN JOSEPH BRODERICK-CANTWELL MD (OWNER)
(251) 517-5800
Entity
Organization
Contact information
Practice address
770 MIDDLE ST, FAIRHOPE, AL 36532-1766
(251) 517-5800
(251) 517-5801
Mailing address
PO BOX 392, FAIRHOPE, AL 36533-0392
(251) 517-5800
(251) 517-5801
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
28950
AL
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28950
MEDICAL LICENSE
AL
Enumeration date
06/19/2017
Last updated
01/10/2018
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