CHARLES P BRODERICK (NPI# 1407808280) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407808280 |
| Entity Type | Individual |
| Full Name | CHARLES P BRODERICK |
| Credential | PHD |
| Practice Address |
10333 El Camino Real Atascadero CA 93423-7001 |
| Mailing Address |
1600 9th St Room 205 Mailstop 2 3 Sacramento CA 95814-6414 |
| Practice Telephone | 8054682000 |
| Practice Fax Number | 8054666011 |
| Mailing Telephone | 9166542431 |
| Mailing Fax Number | 9169543186 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PSY17352 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992037568 | Charles David Broderick | Pharmacist | 10405 N La Canada Dr, Oro Valley, AZ 85737-6945 | 2010-02-08 |
| Street Address |
10333 EL CAMINO REAL |
| City | ATASCADERO |
| State | CA |
| Zip Code | 93423-7001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578565628 | Olga A Yahontova | Psychiatry & Neurology | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2005-06-01 |
| 1699385294 | Kathleen Trotta | Psychologist | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2020-08-07 |
| 1346875960 | Elizabeth Ann Schmidt | Nurse Practitioner | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2020-03-04 |
| 1811521578 | Maria Lourdes Maningding Martinez | Nurse Practitioner | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2020-03-02 |
| 1154968907 | Kacee M Stagg | Dietitian, Registered | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2019-11-27 |
| 1306482344 | Lester James Willis | Nurse Practitioner | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2019-11-25 |
| 1053968552 | Michael Bormacoff Jr. | Psychologist | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2019-08-20 |
| 1649826264 | Jacek Cieply | Nurse Practitioner | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2019-08-11 |
| 1164991220 | David Pyo | Psychologist | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2018-11-19 |
| 1407324387 | Travis Mcgee | Psychologist | 10333 El Camino Real, Atascadero, CA 93422-5808 | 2018-11-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417181108 | Michael Dennis Harmon | Psychologist | 7001 El Camino Real, Atascadero, CA 93423 | 2009-05-08 |
| 1932518529 | Gregory Murphy | Counselor | 10801 El Camino Real, Chalk Mountain Community School, Atascadero, CA 93423 | 2014-08-07 |
| 1770777609 | Cheryll A Hoeller | Psychologist | 10333 Elcamino Real, Atascadero, CA 93423-7001 | 2007-09-04 |
| 1386838100 | Krys D Hunter | Psychologist | 10333 Elcamino Real, Atascadero, CA 93423-7001 | 2007-09-05 |
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174540645 | Peter Robert Russell | Clinical Neuropsychologist | 10420 El Camino Real, Atascadero, CA 93422-6882 | 2006-07-17 |
| 1497791743 | Karen Sue Sheppard | Clinical Neuropsychologist | 10333 El Camino Real, Atascadero, CA 93423-7001 | 2006-06-22 |
| 1275585002 | Leslie Joe Bolin | Clinical Neuropsychologist | 10333 El Camino Real, Atascadero, CA 93422 | 2006-05-17 |
| 1578515730 | Christine Marie Mathiesen | Clinical Neuropsychologist | 10333 El Camino Real, Atascadero, CA 93423-7001 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407455108 | Chelsea Vilinskas | Clinical Neuropsychologist | 2624 Larkey Ln, Walnut Creek, CA 94597-2439 | 2020-10-22 |
| 1417554049 | Andrea Alioto | Clinical Neuropsychologist | 247 San Carlos Ave, Redwood City, CA 94061-3518 | 2020-10-06 |
| 1265045975 | Well Psychology, Inc. | Clinical Neuropsychologist | 3525 Del Mar Heights Rd # 1881, San Diego, CA 92130-2199 | 2020-08-24 |
| 1922618917 | Alyssa Weakley | Clinical Neuropsychologist | Uc Davis Midtown Neurology Clinic, 3160 Folsom Blvd, Sacramento, CA 95816 | 2020-08-04 |
| 1437767399 | Ni Sun-suslow | Clinical Neuropsychologist | 220 Dickinson St # B, San Diego, CA 92103-2071 | 2020-07-16 |
| 1366061707 | Talia Rose Seider | Clinical Neuropsychologist | 760 Westwood Plz Ste 37-360b, Los Angeles, CA 90024-5055 | 2020-04-15 |
| 1699394270 | Colin Jarred Gallagher | Clinical Neuropsychologist | 760 Westwood Plz # C8-854, Los Angeles, CA 90095-8353 | 2020-04-13 |
| 1649807058 | Nicholas S. Thaler Phd A Psychological Corporation | Clinical Neuropsychologist | 1526 14th St Ste 109, Santa Monica, CA 90404-3320 | 2020-03-25 |
| 1447890116 | Hussah Alkharafi | Clinical Neuropsychologist | 2720 Neilson Way # 5701, Santa Monica, CA 90405-4060 | 2020-01-10 |
| 1609414788 | Linda Rice | Clinical Neuropsychologist | 617 Bluegrass St, Simi Valley, CA 93065-5460 | 2019-12-19 |
| Find all providers with the same taxonomy | ||||
| City | ATASCADERO |
| Zip Code | 93423 |
Please comment or provide details below to improve the information on CHARLES P BRODERICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.