Nellie Catherine Broderick, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

120558 Issued in MA

Practice address

77 Court St Apt 212
Newton, MA 02458-1465

Phone

(857) 301-9975

NPI assigned

Aug 3, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Nellie Broderick Licsw, LLC

  • Clinical Social Worker
  • Newton, MA
  • NPI 1053921346
  NPD Authorized official

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

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1902416290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 HIGHLAND AVE # 1006",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024943025",
            "telephone_number": "857-301-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 COURT ST APT 212",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024581465",
            "telephone_number": "857-301-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "NELLIE",
        "middle_name": "CATHERINE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "120558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regan Bristol
• Brittany Archangela Brita
• Brandi Leigh Britnell
• Steven N Broder, PHD
• Kaitlyn Broderick
• Steven J. Brodhead, O.D.
• Leslie Gary Brody, MSW, LICSW, PHD
• Elizabeth Brooks
• Nicole Brooks, RDN
• Jesse Matthew Brousseau

• Clinical Social Worker in Newton, MA
• Providers in Newton, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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.