Provider Demographics
NPI:1679154165
Name:BRODSKY WELLNESS LLC
Entity type:Organization
Organization Name:BRODSKY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, LCADC
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-839-2130
Mailing Address - Street 1:18 KINGS HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2509
Mailing Address - Country:US
Mailing Address - Phone:732-359-2212
Mailing Address - Fax:
Practice Address - Street 1:18 KINGS HWY STE 202
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2509
Practice Address - Country:US
Practice Address - Phone:732-359-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty