Kristin Kathleen Broderick, LCM
Individual provider Active NPI Marriage & Family Therapist · Reisterstown, MD
NPI 1962772129 · NPPES record last updated Aug 25, 2014
Key facts
- NPI
- 1962772129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 000635 (PA)
- Practice address
- 100 Owings Court
Suite 8
Reisterstown, MD 21136 - Phone
- (410) 526-7100
- Fax
- (410) 526-7138
- NPI assigned
- Jan 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000635 | PA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 000635 | PA | Yes |
Addresses
Primary practice location
100 Owings Court
Suite 8
Reisterstown, MD 21136
Mailing address
10400 Ridgland Road
Ste 1
Cockeysville, MD 21030
Phone (410) 628-6120
Other names
- Miss Kristin Kathleen Cassidy
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- Melissa Brendel
- Tracy Brenton
- Beth Lea Brewster
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- Amanda Britton
- Melanie Brower
- Monica Marie Brown
- Philip Browning
- Sheila L Bryant
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All providers in Reisterstown, MD · Marriage & Family Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.