Sheila Eileen Broderick, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C000912 Issued in NC

Practice address

1400 Arnette Ave
Durham, NC 27707-1604

Phone

(919) 972-9958

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Optometric Eye Care Center of Durham PA

  • Optometrist
  • Durham, NC
  • NPI 1205819547
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1437259686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 ARNETTE AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277071604",
            "telephone_number": "919-972-9958",
            "fax_number": "919-308-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 ARNETTE AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277071604",
            "telephone_number": "919-972-9958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "SHEILA",
        "middle_name": "EILEEN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C000912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH PROVIDER NUMBER",
            "identifier": "651197169",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PROVIDER NUMBER",
            "identifier": "343264",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002361",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "130YH",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER NUMBER",
            "identifier": "651197169",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN PROVIDER NUMBER",
            "identifier": "318282",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PROVIDER NUMBER",
            "identifier": "456981000",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gail Pacharis Brock, NP
• Paul Talmage Brock II, CRNA
• Joshua Broder
• Amanda Rose Broderick, MD
• Jamilah Aisha Broderick, PA-C
• Miriam Marie Brodersen, LCSW
• Ilana Renee Brodzki, PHD
• Sanja Broer
• Joseph Brogan, M.D.
• Jeremy Edward Brogden, LCSW, BCD

• All providers in Durham, NC
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; 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.