Provider Demographics
NPI:1285423327
Name:BRODY, DANNETE PAGE
Entity type:Individual
Prefix:
First Name:DANNETE
Middle Name:PAGE
Last Name:BRODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAGE
Other - Middle Name:
Other - Last Name:BRODY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CGC
Mailing Address - Street 1:830 HARRISON AVE BLDG 3200
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2905
Mailing Address - Country:US
Mailing Address - Phone:617-414-1425
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVE BLDG 3200
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-414-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC788170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS