Provider Demographics
NPI:1639199706
Name:BROYDE, STEVEN J (LCSW, PHD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:J
Last Name:BROYDE
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BLOOMFIELD AVE.
Mailing Address - Street 2:STE A
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117
Mailing Address - Country:US
Mailing Address - Phone:860-236-1927
Mailing Address - Fax:
Practice Address - Street 1:333 BLOOMFIELD AVE.
Practice Address - Street 2:STE A
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117
Practice Address - Country:US
Practice Address - Phone:860-236-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0019711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004083672Medicaid
CTC01422Medicare ID - Type Unspecified