Angela Jayne Broussard, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.2106441 Issued in OH

Practice address

3095 Kettering Blvd FL 4
Moraine, OH 45439-1983

Phone

(937) 293-8300

Fax

(937) 913-1913

NPI assigned

Apr 5, 2018

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 28, 2022.

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1992201172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD FL 4",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300",
            "fax_number": "937-913-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD FL 4",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300",
            "fax_number": "937-913-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "ANGELA",
        "middle_name": "JAYNE",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2106441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brigid'S Path
• Emily Nicole Broad, LISW-S
• Rana Lynn Brock
• Michael P. Brockman
• Bryelle L Broome, PCC-S
• Andrew Brown, MS/LPCC
• Camron Brown
• Colleen Marie Brown
• Deanna Brown
• Shanice Alexandra Brown

• All providers in Moraine, OH
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.