Individual
PROF. JOAN BRODERICK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
SUNY PUTNAM HALL RM 103, STONY BROOK, NY 11794-0001
(631) 632-3106
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 632-3106
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
006567
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00663194
—
NY
Enumeration date
06/08/2006
Last updated
07/08/2007
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