Emily Nicole Broad, LISW-S
Individual provider Active NPI Clinical Social Worker · Moraine, OH
NPI 1043725971 · NPPES record last updated Feb 23, 2026
Key facts
- NPI
- 1043725971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I.2103012-SUPV (OH)
- Practice address
- 3095 Kettering Blvd
Moraine, OH 45439-1983 - Phone
- (937) 293-8300
- NPI assigned
- Dec 14, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Psychological and Behavioral Consultants LLC
Practice addresses (Care Compare)
25101 Chagrin Blvd
Suite 100
Beachwood, OH 44122-5694
Phone (216) 831-6611
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210901000601 | OH | Practitioner - Clinical Social Worker | 2961808878 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.2103012-SUPV | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological & Behavioral Consultants, LLC | Clinical | Current |
Accepting new patients |
Locations
25101 Chagrin Blvd
Ste 100
Beachwood, OH 44122
Phone (216) 245-4468
2900 Presidential Dr
Ste 100
Beavercreek, OH 45324
Phone (513) 741-3100
6601 Centerville Business Pkwy
Ste 310
Dayton, OH 45459
Phone (937) 637-3765
25111 Country Club Blvd
Ste 290
North Olmsted, OH 44070
Phone (440) 614-2520
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I.2103012-SUPV | OH | Yes |
Addresses
Primary practice location
3095 Kettering Blvd
Moraine, OH 45439-1983
Mailing address
3095 Kettering Blvd
Moraine, OH 45439-1983
Other providers in Moraine, OH
- Christyn Brewer
- John Alfred Breyer
- Brigid'S Path
- Brigid'S Path
- Brigid'S Path
- Rana Lynn Brock
- Michael P. Brockman
- Bryelle L Broome
- Angela Jayne Broussard
- Andrew Brown
All providers in Moraine, OH · Clinical Social Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.