Provider Demographics
NPI:1609952498
Name:BROUSSARD, ROBERT F (DMIN)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 BOSTON STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1200
Mailing Address - Country:US
Mailing Address - Phone:978-887-2448
Mailing Address - Fax:978-774-9218
Practice Address - Street 1:462 BOSTON STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1200
Practice Address - Country:US
Practice Address - Phone:978-887-2448
Practice Address - Fax:978-774-9218
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02596OtherBLUE CROSS BLUE SHIELD
MAW02596Medicare ID - Type Unspecified