Provider Demographics
NPI:1174621908
Name:BRODERICK, JANNESS MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANNESS
Middle Name:MARIE
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 CALLE CERRITO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-898-1276
Mailing Address - Fax:
Practice Address - Street 1:735 STATE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3351
Practice Address - Country:US
Practice Address - Phone:805-689-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical