Keisha Lynne Broyles, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14585 Issued in MD

Practice address

5626 Southwestern Blvd Ste C
Halethorpe, MD 21227-3921

Phone

(443) 267-7775

Fax

(443) 327-4751

NPI assigned

Aug 20, 2009

Last updated

Aug 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keishabroyles@tdh.allscriptsdirect.net

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.

• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MD

  Medicare reassignment NPD
• Serenity and Sage Counseling, LLC

  dba Keisha Broyles

  • Clinical Social Worker
  • Baltimore, MD
  • NPI 1306410196
  NPD Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1689806929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 SOUTHWESTERN BLVD STE C",
            "city": "HALETHORPE",
            "state": "MD",
            "postal_code": "212273921",
            "telephone_number": "443-267-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5626 SOUTHWESTERN BLVD STE C",
            "city": "HALETHORPE",
            "state": "MD",
            "postal_code": "212273921",
            "telephone_number": "443-267-7775",
            "fax_number": "443-327-4751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 Mercantile Ln Ste 129-53",
            "address_purpose": "LOCATION",
            "city": "Largo",
            "state": "MD",
            "postal_code": "207745327",
            "country_code": "US",
            "telephone_number": "443-267-7775",
            "fax_number": "443-327-4751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROYLES",
        "first_name": "KEISHA",
        "middle_name": "LYNNE",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-20",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "14585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bright Horizons Behavioral Health Incorporated
• Bright Horizons Behavioral Health Incorporated
• Bright Horizons Behavioral Health Incorporated
• Hannah Broadwater, D.P.T.
• Deshawna D Brown
• Catherine Young Campbell, M.D.
• Elizabeth M Carter, D.O.
• Caron Marie Casciato, PSYCHOLOGIST
• Grace Gia-Ling Wong Casserly, MD
• Martha J Chalmers, M.D.

• Clinical Social Worker in Halethorpe, MD
• Providers in Halethorpe, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.