Provider Demographics
NPI:1114818887
Name:BROADBENT, CHANDLER (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:
Last Name:BROADBENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7381
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0381
Mailing Address - Country:US
Mailing Address - Phone:909-353-7403
Mailing Address - Fax:
Practice Address - Street 1:904 JUDSON ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3841
Practice Address - Country:US
Practice Address - Phone:909-353-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical