Active NPI
Carol Ann Brodersen, LPC
- Contractor
- San Antonio, TX
National Provider Identifier
1659526572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 17673
- Practice address
- 411 Cardinal Way
San Antonio, TX 78253-5614 - Phone
- (210) 277-7470
- Fax
- (210) 706-7466
- NPI assigned
- Nov 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 17673 | TX | Primary |
Addresses
Primary practice location
411 Cardinal Way
San Antonio, TX 78253-5614
Mailing address
411 Cardinal Way
San Antonio, TX 78253-5614
Phone (210) 277-7470
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227052800000",
"number": "1659526572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 CARDINAL WAY",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782535614",
"telephone_number": "210-277-7470",
"fax_number": "210-706-7466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 CARDINAL WAY",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782535614",
"telephone_number": "210-277-7470",
"fax_number": "210-706-7466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERSEN",
"first_name": "CAROL",
"middle_name": "ANN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-19",
"last_updated": "2008-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "TX",
"license": "17673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.