NPIMap

Organization Active NPI

Lesley Brodie, M.D., P.C.

  • Adolescent and Children Mental Health Clinic/Center
  • Manchester Center, VT
National Provider Identifier
1114347440
Registry record updated Apr 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
042.0012150 Issued in VT
Legal business name
LESLEY BRODIE, M.D., P.C.
Practice address
82 Elm Street
Manchester Center, VT 05255-9642
Phone
(802) 367-1068
Fax
(802) 367-1069
NPI assigned
Apr 25, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lesley Thompson Brodie, M.D.NPI 1720050552
Title
Officer/Member
Phone
(802) 367-1068

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 042.0012150 VT
Adolescent and Children Mental Health Clinic/Center 261QM0855X 042.0012150 VT Primary

Addresses

Primary practice location

82 Elm Street
Manchester Center, VT 05255-9642

Mailing address

PO Box 766
Manchester, VT 05254-0766
Phone (802) 367-1068

Other identifiers 1

IdentifierTypeStateIssuer
1019286MedicaidVT

National Provider Directory

National Provider Directory

Locations

82 Elm St
Manchester Center, VT 05255
Phone (508) 364-4331

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398384000000",
    "number": "1114347440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 766",
            "city": "MANCHESTER",
            "state": "VT",
            "postal_code": "052540766",
            "telephone_number": "802-367-1068",
            "fax_number": "802-367-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 ELM STREET",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052559642",
            "telephone_number": "802-367-1068",
            "fax_number": "802-367-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LESLEY BRODIE, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-25",
        "last_updated": "2014-04-25",
        "status": "A",
        "authorized_official_last_name": "BRODIE",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_middle_name": "THOMPSON",
        "authorized_official_title_or_position": "OFFICER/MEMBER",
        "authorized_official_telephone_number": "802-367-1068",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "VT",
            "license": "042.0012150",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VT",
            "license": "042.0012150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019286",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester Center, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.