Active NPI
Emily Broadhurst
- Clinical Psychologist
- Antioch, CA
National Provider Identifier
1669919064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY34627
- Practice address
- 509 W 10TH St
Antioch, CA 94509-1653 - Phone
- (925) 777-9540
- NPI assigned
- Jan 23, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY34627 | CA | |
| Clinical Psychologist | 103TC0700X | PSY34627 | CA | Primary |
Addresses
Primary practice location
509 W 10TH St
Antioch, CA 94509-1653
Mailing address
427 E Century Blvd
Lodi, CA 95240-8810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34627 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700611200000",
"number": "1669919064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "427 E CENTURY BLVD",
"city": "LODI",
"state": "CA",
"postal_code": "952408810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 W 10TH ST",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945091653",
"telephone_number": "925-777-9540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROADHURST",
"first_name": "EMILY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-23",
"last_updated": "2023-11-22",
"certification_date": "2023-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY34627",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY34627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.