Provider Demographics
NPI:1053957662
Name:BRODOFF, REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRODOFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3692 BEDFORD AVE STE P2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1702
Mailing Address - Country:US
Mailing Address - Phone:646-837-5557
Mailing Address - Fax:646-837-5495
Practice Address - Street 1:3692 BEDFORD AVE STE P2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1702
Practice Address - Country:US
Practice Address - Phone:646-837-5557
Practice Address - Fax:646-837-5495
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical