Individual
MATTHEW STUART BROUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2239F TACKETTS MILL DRIVE, LAKE RIDGE, VA 22192
(703) 490-0336
(703) 490-4525
Mailing address
2239F TACKETTS MILL DRIVE, LAKE RIDGE, VA 22192
(703) 490-0336
(703) 490-4525
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003712
VA
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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