Basic Information
| Provider Information | |||||||||
| NPI: | 1174915086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRODHEAD | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 S BROADWAY | ||||||||
| Address2: | SUITE 364 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945965294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252952987 | ||||||||
| FaxNumber: | 9252955226 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 S BROADWAY | ||||||||
| Address2: | SUITE 364 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945965294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252952987 | ||||||||
| FaxNumber: | 9252955226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2015 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 26824 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.