Provider Demographics
NPI:1821866229
Name:BROADBENT, PATRICIA A (PSY D)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BROADBENT
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HALSEY DR
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1225
Mailing Address - Country:US
Mailing Address - Phone:203-940-3292
Mailing Address - Fax:
Practice Address - Street 1:151 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6381
Practice Address - Country:US
Practice Address - Phone:203-962-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist