Broken by Violence

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

BROKEN BY VIOLENCE

Practice address

840 E Travis Blvd Apt 308
Fairfield, CA 94533-5323

Phone

(209) 688-4614

NPI assigned

Feb 13, 2025

Organization subpart

No

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

Authorized official

Name

Ebony Antoine

Title

Exceutive Director

Phone

(209) 688-4614

Specialties & licenses 1

Addresses

Other names 1

• Broken By Violence Doing business as

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

{
    "created_epoch": "1739404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1700681822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 E TRAVIS BLVD APT 308",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945335323",
            "telephone_number": "209-688-4614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E TRAVIS BLVD APT 308",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945335323",
            "telephone_number": "209-688-4614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROKEN BY VIOLENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-13",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "ANTOINE",
        "authorized_official_first_name": "EBONY",
        "authorized_official_title_or_position": "EXCEUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-688-4614"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broken By Violence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Severino Bright, MFT-I
• Kayla Marie Briley
• Mariah Lynnette Brisco
• Anthony Briscoe
• Joseph Briscoe
• James B Bronk, M.D.
• Kirbee Brooks, MPH
• Latifah Brooks
• Alexus Broom, LMFT
• Stepheney Michelle Brosamle I

• Community/Behavioral Health Agency in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.