Provider Demographics
NPI:1053564971
Name:BRODIE, BARBARA LESLIE (LCSW-C)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LESLIE
Last Name:BRODIE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 YORK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6035
Mailing Address - Country:US
Mailing Address - Phone:410-494-4495
Mailing Address - Fax:410-494-4496
Practice Address - Street 1:1301 YORK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6035
Practice Address - Country:US
Practice Address - Phone:410-494-4495
Practice Address - Fax:410-494-4496
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09861104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD130M056FMedicare PIN