Gilda G Broadwell, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5591 Issued in FL

Practice address

500 NW Dixie Hwy
Suite 102
Stuart, FL 34994-1186

Phone

(772) 692-8585

Fax

(772) 692-5651

NPI assigned

May 1, 2007

Sex

Female

Sole proprietor

No

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 FL

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Serenity Counseling Services PA

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Stuart, FL
  • NPI 1275689812

  Psychologist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1942421995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2474",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349952474",
            "telephone_number": "772-692-8585",
            "fax_number": "772-692-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 NW DIXIE HWY",
            "address_2": "SUITE 102",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349941186",
            "telephone_number": "772-692-8585",
            "fax_number": "772-692-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWELL",
        "first_name": "GILDA",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bright Self Medicine LLC
• Tracy Ann Brigida
• Caroline Pels Brinkley, RBT
• Josue Brito
• Broader MRI of Stuart, LLC
• Bernard Broaster
• Mara Broderick
• Megan M Bronaut, RBT
• Brookdale Senior Living Communities, Inc.
• Courtney Brooks

• Psychologist in Stuart, FL
• Providers in Stuart, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.