Active NPI
Carolina Family Psychiatry, LLC
- Psychiatry Physician
- Mount Pleasant, SC
National Provider Identifier
1124176896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 28903
- Legal business name
- CAROLINA FAMILY PSYCHIATRY, LLC
- Practice address
- 300 W Coleman Blvd
Suite 201
Mt Pleasant, SC 29464-3429 - Phone
- (843) 971-9495
- Fax
- (843) 971-9697
- NPI assigned
- Jan 8, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. John J. Broderick-Cantwell, M.D.
- Title
- Sole Proprietor
- Phone
- (843) 971-9495
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 28903 | SC | Primary |
Addresses
Primary practice location
300 W Coleman Blvd
Suite 201
Mt Pleasant, SC 29464-3429
Mailing address
300 W Coleman Blvd
Suite 201
Mt Pleasant, SC 29464-3429
Phone (843) 971-9495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28903 | Other | SC | STATE LICENSE |
National Provider Directory
National Provider DirectoryLocations
300 W Coleman Blvd
Ste 201
Mt Pleasant, SC 29464
Phone (843) 971-9495
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1124176896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W COLEMAN BLVD",
"address_2": "SUITE 201",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294643429",
"telephone_number": "843-971-9495",
"fax_number": "843-971-9697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W COLEMAN BLVD",
"address_2": "SUITE 201",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294643429",
"telephone_number": "843-971-9495",
"fax_number": "843-971-9697"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAROLINA FAMILY PSYCHIATRY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-08",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BRODERICK-CANTWELL",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "SOLE PROPRIETOR",
"authorized_official_telephone_number": "843-971-9495",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "28903",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "28903",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, SC
- Carolina Family Care Inc (MUSC Physicians PC)
- Carolina Family Care, Inc (MUSC Physicians PCP Ben Sawyer Family Medicine)
- Carolina Family Care, Inc (MUSC Health Spine Physical Medicine & Rehabilitation - Mt Pleasant)
- Carolina Family Care, Inc (MUSC Physicians PCP Sweetgrass Family Medicine)
- Carolina Family Care, Inc (MUSC Physicians PCP Lab)
- Carolina Foot & Ankle Specialists, LLC
- Carolina Hand Therapy Inc
- Carolina Hand Therapy Inc
- Carolina Hormone and Health Center of Charleston
- Carolina Hospice Care, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.