Mary Kathleen Broderick, MS ED

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

008816 Issued in NY

Practice address

25 Van Rensselaer Dr
Rensselaer, NY 12144-1491

Phone

(518) 436-4618

NPI assigned

Sep 15, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Rensselaer City School District

  • Local Education Agency (LEA)
  • Rensselaer, NY
  • NPI 1851448922
  NPD (past)

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1699057679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 SUNBURN LN",
            "city": "CLARKSVILLE",
            "state": "NY",
            "postal_code": "120411209",
            "telephone_number": "518-768-8048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 VAN RENSSELAER DR",
            "city": "RENSSELAER",
            "state": "NY",
            "postal_code": "121441491",
            "telephone_number": "518-436-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "credential": "MS ED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "008816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Bouleris
• Virginia L. Bourdeau, RPH
• Robin F Boyd
• Wendy Ann Brennan
• Mary Anne Breton
• Donna Brown
• Deborah Brubaker
• C & L Transport Inc.
• Madonna Cabangbang, RN
• Steven H Calderon, DMD

• Speech-Language Pathologist in Rensselaer, NY
• Providers in Rensselaer, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.