Brad Stephen Broeder, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY-5583 Issued in FL

Practice address

1266 First Street, Suite #11
Sarasota, FL 34236-5519

Phone

(941) 953-6804

Fax

(941) 953-3704

NPI assigned

Aug 29, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219968000000",
    "number": "1912155144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1266 FIRST STREET, SUITE #11",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342365519",
            "telephone_number": "941-953-6804",
            "fax_number": "941-953-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1266 FIRST STREET, SUITE #11",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342365519",
            "telephone_number": "941-953-6804",
            "fax_number": "941-953-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROEDER",
        "first_name": "BRAD",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "FL",
            "license": "PY-5583",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "FL",
            "license": "PY-5583",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY-5583",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY-5583",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "FL",
            "license": "PY-5583",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "FL",
            "license": "PY-5583",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gregory Broderick
• Diane Broehm
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• Clinical Psychologist in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.

Verify at the official NPI Registry.