Individual
DR. MICHAEL BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
491 STEVENS AVE, PORTLAND, ME 04103-2636
(207) 329-5915
Mailing address
491 STEVENS AVE, PORTLAND, ME 04103-2636
(207) 329-5915
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS908
ME
Other
Enumeration date
05/28/2007
Last updated
07/09/2007
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