Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 8026 | MA |
Y | 103TC0700X | Clinical Psychologist | 8026 | MA |
NPI | 1003308131 |
---|---|
Provider Name | Dr. Natalie Yvonne Broderick |
First Address | Stanley, HONG KONG 00000 |
Second Address | Stanley, HONG KONG 00000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 04/06/2018 |