Kristin E Broderick, LPC, CAADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC009748 Issued in GA

Practice address

300 Commercial CT Ste F
Savannah, GA 31406-2676

Phone

(912) 503-5744

Fax

(913) 335-6559

NPI assigned

Oct 26, 2017

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

State licenses

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.

• Madeleine Shaver, LCSW LLC

  • Clinical Social Worker
  • Savannah, GA
  • NPI 1578070504

  Professional

  NPD (past)

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1982116216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 COMMERCIAL CT STE 102",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063675",
            "telephone_number": "912-503-5744",
            "fax_number": "912-335-6559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COMMERCIAL CT STE F",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062676",
            "telephone_number": "912-503-5744",
            "fax_number": "913-335-6559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "KRISTIN",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "LPC, CAADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-26",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgianna Broadwell, LD
• Chad Brock, MD
• Elizabeth Brannen Brock, L.C.S.W
• Gina Brock, DO
• Matthew Brockman
• Patrick Thomas Broderick, MD
• Thomas Broderick, D.D.S., M.S.
• Deveney Brodersen, RBT
• Sonia Brodeur-Lyons, OT
• Benjamin Richard Brodhead, L.AC.

• Professional Counselor in Savannah, GA
• Providers in Savannah, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.