Active NPI
Jennifer A Broderick, PSY.D.
- Clinical Psychologist
- Frisco, TX
National Provider Identifier
1003185372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY8263
- Practice address
- 12938 Ablingdon Dr
Frisco, TX 75035 - Phone
- (954) 551-6352
- NPI assigned
- Dec 15, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY8263 | FL | Primary |
Addresses
Primary practice location
12938 Ablingdon Dr
Frisco, TX 75035
Mailing address
12938 Ablingdon Dr
Frisco, TX 75035-8807
Phone (954) 551-6352
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY8263 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444176000000",
"number": "1003185372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12938 ABLINGDON DR",
"city": "FRISCO",
"state": "TX",
"postal_code": "750358807",
"telephone_number": "954-551-6352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12938 ABLINGDON DR",
"city": "FRISCO",
"state": "TX",
"postal_code": "75035",
"telephone_number": "954-551-6352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "JENNIFER",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-15",
"last_updated": "2015-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY8263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frisco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.