Provider Demographics
NPI:1003562174
Name:BROADHEAD, CATHERINE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MICHELLE
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4733
Mailing Address - Country:US
Mailing Address - Phone:858-220-5713
Mailing Address - Fax:
Practice Address - Street 1:852 HEATHER WAY
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4733
Practice Address - Country:US
Practice Address - Phone:858-220-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty