Individual provider Active NPI

Corinne Brodnicki, M.A. LMFT

  • Marriage & Family Therapist
  • Roseville, CA
National Provider Identifier
1669724506
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
1212 Coloma Way Ste D
Roseville, CA 95661-4646
Phone
(916) 407-4711
NPI assigned
Oct 2, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X CA Primary

Addresses

Primary practice location

1212 Coloma Way Ste D
Roseville, CA 95661-4646

Mailing address

1212 Coloma Way Ste D
Roseville, CA 95661-4646
Phone (916) 407-4711

Other practice location 1

2750 Sutterville Rd # Cottage2
Sacramento, CA 95820-1024
Phone (916) 290-8149

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jul 30, 2025 through Jul 30, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
85494CAMDDental Assistant

NPI Registry JSON

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1669724506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 COLOMA WAY STE D",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614646",
            "telephone_number": "916-407-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 COLOMA WAY STE D",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614646",
            "telephone_number": "916-407-4711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2750 Sutterville Rd # Cottage2",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958201024",
            "country_code": "US",
            "telephone_number": "916-290-8149",
            "fax_number": "916-456-4636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRODNICKI",
        "first_name": "CORINNE",
        "credential": "M.A. LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.