Individual
AMANDA V BRODERICK
Active
Individual
AMANDA V BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20043498A
IN
103TB0200X
Cognitive & Behavioral Psychologist
Primary
20043498A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300054677
—
IN
Enumeration date
08/05/2021
Last updated
05/19/2025
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