Kathleen Louise Broad, M.D.
Individual provider Active NPI Psychiatry Physician · West Haven, CT
NPI 1013368240 · NPPES record last updated Jun 29, 2016
Key facts
- NPI
- 1013368240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 055144 (CT)
- Practice address
- 950 Campbell Ave
Room 151D
West Haven, CT 06516-2770 - Phone
- (203) 932-5711
- NPI assigned
- Jun 29, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055144 | CT | MD | Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 055144 | CT | Yes |
Addresses
Primary practice location
950 Campbell Ave
Room 151D
West Haven, CT 06516-2770
Mailing address
950 Campbell Ave
Room 151D
West Haven, CT 06516-2770
Phone (203) 932-5711
Other providers in West Haven, CT
- Alison Breen
- Elizabeth G Brennan
- Gina R Brescia
- Kelli Brice
- Devin Briggs
- Adrian Clifford Brooks III
- Meghan E Brooks
- Jennifer Brothers
- Nickesha Marie Brown-Fokuo
- Angela J Brown
All providers in West Haven, CT · Psychiatry Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.