Patricia McCarthy Broderick, PHD, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701004934 Issued in VA

Practice address

21 Fort Evans Rd NE Ste B
Leesburg, VA 20176-4488

Phone

(703) 443-6917

NPI assigned

Feb 21, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Patricia Lea McCarthy Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Redeemed Way Christian Counseling, LLC

  • Mental Health Counselor
  • Ashburn, VA
  • NPI 1588309421
  NPD Authorized official

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1295075695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44691 WELLFLEET DR APT 306",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201472570",
            "telephone_number": "703-608-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 FORT EVANS RD NE STE B",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764488",
            "telephone_number": "703-443-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "PATRICIA",
        "middle_name": "MCCARTHY",
        "credential": "PHD, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-21",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "0701004934",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701004934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "patti@redeemedway.com",
            "affiliation": "N",
            "endpointDescription": "E-mail Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "44691 Wellfleet Dr Apt 306",
            "city": "Ashburn",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201472570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "MCCARTHY",
            "middle_name": "LEA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.