Active NPI
Daniel John Broderick, PHD
- Clinical Psychologist
- Murfreesboro, TN
National Provider Identifier
1366635518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20041132A
- Practice address
- 3528 Chianti Cir
Murfreesboro, TN 37129-4272 - Phone
- (765) 808-1687
- NPI assigned
- Aug 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | |||
| Clinical Psychologist | 103TC0700X | 20041132A | IN | Primary |
Addresses
Primary practice location
3528 Chianti Cir
Murfreesboro, TN 37129-4272
Mailing address
3528 Chianti Cir
Murfreesboro, TN 37129-4272
Phone (765) 808-1687
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200532030A | Medicaid | IN |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041132A | IN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integral Health Psychology Services, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Muncie, IN
- NPI 1851421929
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1366635518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3528 CHIANTI CIR",
"city": "MURFREESBORO",
"state": "TN",
"postal_code": "371294272",
"telephone_number": "765-808-1687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3528 CHIANTI CIR",
"city": "MURFREESBORO",
"state": "TN",
"postal_code": "371294272",
"telephone_number": "765-808-1687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "DANIEL",
"middle_name": "JOHN",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-21",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20041132A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200532030A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Murfreesboro, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.