Paula Patricia Daine-de Broux, MA, LICSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9290-123 Issued in WI

Practice address

2501 Hanley Rd Ste 101
Hudson, WI 54016-8786

Phone

(715) 954-5300

Fax

(715) 954-5301

NPI assigned

Apr 9, 2013

Last updated

Apr 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Paula Patricia Daine Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nest Professional Service Corp

  dba The NEST

  • Community/Behavioral Health Agency
  • Stillwater, MN
  • NPI 1508314071
  Medicare reassignment NPD
• Mary Mullenbach, PHD, LP, Inc

  dba Legacy Mental Health Center

  • Psychologist
  • Edina, MN
  • NPI 1801182837
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1588007512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165427",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 HANLEY RD STE 101",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168786",
            "telephone_number": "715-954-5300",
            "fax_number": "715-954-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAINE-DE BROUX",
        "first_name": "PAULA",
        "middle_name": "PATRICIA",
        "credential": "MA, LICSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-09",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "8662",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9290-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAULA",
            "last_name": "DAINE",
            "middle_name": "PATRICIA",
            "credential": "MA, LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alecia Lyn Dadez
• Beverly Dahl
• Dana M Dahl, MD
• Eric Dahl, MD
• Sarah Kristy Dahle
• Benjamin Jeffrey Danovsky, DPT
• Daulton Physical Therapy, LLC
• Rebekah Dean
• Melissa Mae Deeg, D.D.S.
• Kelly L Delahunty, MD

• Clinical Social Worker in Hudson, WI
• Providers in Hudson, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.