D.a.Brodie,PH.D.P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006340 Issued in MI

Legal business name

D.A.BRODIE,PH.D.P.C.

Practice address

300 River Place Dr Ste 5350-G
Detroit, MI 48207-4457

Phone

(313) 871-1450

Fax

(313) 468-1105

NPI assigned

Feb 27, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Debra Ann Brodie, PH.D.NPI 1518956259

Title

President

Phone

(313) 871-1450

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debra Ann Brodie, PH.D.

  • Clinical Psychologist
  • Detroit, MI
  • NPI 1518956259
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1267228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623456000000",
    "number": "1710209010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RIVER PLACE DR STE 5350-G",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074457",
            "telephone_number": "313-871-1450",
            "fax_number": "313-468-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIVER PLACE DR STE 5350-G",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074457",
            "telephone_number": "313-871-1450",
            "fax_number": "313-468-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D.A.BRODIE,PH.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-27",
        "last_updated": "2021-06-12",
        "certification_date": "2021-06-12",
        "status": "A",
        "authorized_official_last_name": "BRODIE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-871-1450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.