Dominique Victoria Broadnax, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY10001846 Issued in MA

Practice address

75 Fenwood Rd
Boston, MA 02115-6103

Phone

(617) 626-9300

NPI assigned

Jun 26, 2022

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

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Clinical Psychologist

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Commonwealth of MassachusettsGroup PAC ID 8820906860, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• The Commonwealth of Massachusetts

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boston, MA
  • NPI 1568587913
  Medicare reassignment Care Compare group NPD
• The Commonwealth of Massachusetts

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boston, MA
  • NPI 1073638805
  NPD
• The Commonwealth of Massachusetts

  • General Acute Care Hospital
  • Holyoke, MA
  • NPI 1427111574
  NPD

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

{
    "created_epoch": "1656201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1679205074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FENWOOD RD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FENWOOD RD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156103",
            "telephone_number": "617-626-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "DOMINIQUE",
        "middle_name": "VICTORIA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-26",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS02359",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "PSY10001846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oneil A Britton, MD
• Kate T. Brizzi, MD
• Sarah Elisabeth Brnich
• Tyler Broadfield, MS
• Matthew Stephen Broadhurst, MD
• Alexandra R Broccoli, LMHC
• Morgan Carol Broccoli, M.D.
• Lauren Broccolo
• Blythe N Brochu
• Kerry Elizabeth Brochu, PA

• Clinical Psychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.